Mid term functional and radiological outcomes are comparable between patient specific instrumentation surgery versus conventional total knee arthroplasty
ESSKA Academy. Chen J. Nov 9, 2019; 286388
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Mid term functional and radiological outcomes are comparable between patient specific instrumentation surgery versus conventional total knee arthroplasty

EKA Free Papers

Topic: TKA

Chen J., Liow L., Ang B., Mitra A.K., Koh J., Howe T.S., Yeo S.J., Lim J.
Singapore General Hospital, Singapore, Singapore

Introduction: Patient Specific Instrumentation (PSI) surgery may represent the next promising evolution in the surgical technique for total knee arthroplasty (TKA). However, recent meta-analyses have shown that PSI surgery neither reduces blood loss nor improves the accuracy of implants alignment.
Objectives: There is a paucity of published studies on mid and long term functional outcomes after PSI surgery and our study is designed to fill this gap.
Aims: Our study aims to compare the functional and radiological outcomes in patients five years after PSI surgery versus conventional TKA.
Methods: Power analysis was done prior to the conduct of this study. Sixty patients with osteoarthritis of the knee were prospectively recruited and divided into two groups: 1) PSI surgery, based on pre-operative Magnetic Resonance Imaging scans; 2) Conventional TKA. A fellowship trained surgeon, who was well versed in both techniques, performed all the surgeries using posterior stabilized implants. The patients were followed up for five years using Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36. Three radiographic measurements were recorded on postoperative long leg radiograph: 1) Hip-Knee-Ankle Angle (HKA); 2) Coronal Femoral-Component Angle (CFA); 3) Coronal Tibia-Component Angle (CTA).
Results: There was no difference in patients' age, gender and Body Mass Index between the two groups (all p>0.05). The duration of surgery was 58 ± 7 minutes for both groups (p=0.754). There were no superficial or deep infections in either group and none of the patients required revision surgery. The KSFS, KSKS, OKS and MCS at five years follow up were comparable between the two groups (all p>0.05). The PCS in the PSI group was 5 ± 2 points worse at five years after surgery compared to the Conventional group (p=0.025). The proportion of outliers for lower limb alignment (HKA) and implant placement (CFA and CTA) were comparable for the PSI and conventional groups (all p>0.05). However, most of the outliers for HKA had valgus deformity in the PSI group but varus deformity in the conventional group (p=0.007).
Conclusions: This study represents the longest clinical follow up available for PSI surgery. The authors conclude that PSI surgery does not confer better mid-term functional or radiological outcomes when compared to conventional TKA.
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