Comparison of Clinical, Functional, and Radiological Outcomes of Total Knee Arthroplasty Using Conventional and Patient-Specific Instrumentation

Background: Recently, patient-specific instrumentation (PSI) systems have been developed in order to increase theaccuracy of component positioning during total knee arthroplasty (TKA); however, the findings of previous studies arecontroversial in this regard. In the current randomized clinical study, the outcomes of computer tomography (CT)-basedPS (patient specific)-guided TKA were compared to the results of conventional instrumentation (CVI) TKA. The guideswere designed on the basis of distal femoral and proximal tibial pin orientation of the conventional related guides.Methods: The present study was carried out on 24 TKA candidates randomly assigned to two PSI (n=12) and CVI(n=12) groups. The patients were postoperatively followed for 2 years. Then, the hip-knee-ankle angle (HKAA), femoralcomponent flexion, and orientation of components in the coronal plane were measured. In addition, the WesternOntario and McMaster Universities Osteoarthritis (WOMAC) Index and Knee Society Score (KSS) questionnaire werecompleted for all the patients.Results: The rate of the outliers of the HKAA was higher in the CVI group (41.7% and 8.3%; P=0.077); nevertheless,the difference was not significant in this regard. The rate of the outliers of other radiographic measurements andoperational time were similar in both groups. Furthermore, there was no significant difference between the two groupsin terms of the WOMAC and KSS.Conclusion: The CT-based PS-guided TKA may result in the improved postoperative mechanical alignment of the limband should be considered in complicated TKAs. However, future studies should investigate whether the results of PSITKA support the considerably higher costs of this technique.Level of evidence: II