Patient-specific instrumentation versus conventional instrumentation in total knee arthroplasty

Purpose. To compare patient-specific instrumentation (PSI) with conventional instrumentation in total knee arthroplasty (TKA) in terms of component alignment, operating time, and the learning curve required in a non-teaching hospital. Methods. Records of 33 men and 29 women aged 50 to 88 (mean, 71) years who underwent TKA for osteoarthritis using PSI (n=31) or conventional instrumentation (n=31) by a single surgeon were reviewed. The choice of instrumentation was made by the patient; the surgeon did not express any preference and had not used PSI before. All patients used the same cemented, cruciate-retaining system. Results. The PSI and conventional instrumentation groups were comparable in terms of age, body mass index (BMI), American Society of Anesthesiologists grade, pre- and post-operative haemoglobin level, and the need for blood transfusion. Compared with conventional instrumentation, PSI resulted in a smaller coronal femoral component angle (7.7 degrees vs. 6.4 degrees, p=0.003) and posterior tibial slope angle (6.4 degrees vs. 3.2 degrees, p=0.0001), and smaller variance of the respective angles (p=0.006 and p=0.003). In patients with a BMI >= 30, PSI still resulted in a smaller posterior tibial slope angle (5.8 degrees vs. 3.1 degrees, p=0.015) and variance of the angle (p=0.02). The mean tourniquet time was shorter in the PSI group in all patients (p=0.013) and in patients with BMI kg/m(2) (p=0.0008), and its variance was also smaller in the PSI group (p=0.0004). There was no learning curve required. Conclusion. PSI was simple to use, with no learning curve required. It can be used in non-teaching hospitals and in patients with a high BMI and in cases where the use of an intramedullary alignment guide would be problematic due to previous femoral trauma.