No difference in rate of malalignment between PSI and conventional instruments in TKA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(11):2 Acta Orthop. 2018 Feb;89(1):89-94109 patients scheduled for total knee arthroplasty were randomized to surgery with either the use of patient-specific cutting guides or conventional intra- and extramedullary guides. Patients were assessed for overall lower limb alignment, femoral component alignment in the coronal, sagittal, and axial planes, tibial component alignment in the coronal and sagittal planes, and patient-reported outcome measures and knee range of motion over a 2-year follow-up. Results demonstrated no statistically significant differences between groups in the rate of outliers (>3deg deviation from planned alignment) in any alignment comparison, or in any patient-reported outcome measure or range of motion over a 2-year follow-up.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
2/4
Aleatorización
2/4
Medición de resultados
4/4
Inclusión / exclusión
4/4
Descripción de la terapia
4/5
Estadísticas
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
When first introduced, there was a lot of interest in patient-specific instruments as a method to potentially improve the alignment of components in total knee arthroplasty. As randomized controlled trials have been published on their use, mixed evidence in support of their efficacy has been reported. There is a continued need for high-quality studies on their use in order to determine their role in routine practice for total knee arthroplasty.
Qual era a principal questão de investigação?
In total knee arthroplasty, is there any significant difference in mean component alignment, the incidence of outliers in component alignment (>3deg deviation from planned alignment), or patient-reported outcome measures, over 2 years postoperatively between patient-specific instrumentation and convention instruments?
- The incidence of femoral outliers did not significantly differ between the PSI group and the CONV group in the coronal plane (7/43 vs. 4/47; p=0.3), sagittal plane (29/43 vs. 23/47; p=0.08), or axial plane (5/43 vs. 7/47; p=0.7).
- The incidence of tibial outliers did not significantly differ between the PSI group and the CONV group in the coronal plane (8/43 vs. 3/47; p=0.08) or the sagittal plane (17/43 vs. 26/47; p=0.1).
- The incidence of outliers in HKA angle (reference: neutral alignment) did not significantly differ between the PSI group and the CONV group (11/42 vs. 11/49; p=0.7).
- No significant differences between the PSI group and the CONV group were observed in KOOS scores, NRS pain scores, EQ-5D scores, or knee range of motion in flexion and extension at 3 months, 1 year, or 2 years (all p>0.05).
De que é que me devo lembrar mais?
In total knee arthroplasty, there were no significant differences between cases completed using patient-specific instruments and cases completed using standard intra- and extramedullary guides in rate of overall lower limb malalignment, rate of malalignment of either the femoral component or tibial component individually, or in patient-reported outcome measured and knee range of motion over 2 year follow-up.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that there does not appear to be a clinical benefit to the use of patient-specific instruments over conventional instruments in completing total knee arthroplasties.
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