Abstract
PurposePatient-specific instrumentation (PSI) has the potential to offer numerous benefits—not least of all, improved resection accuracy; but its potential has not been realised in clinical studies. An explanation may be the focus of such studies on the total knee replacement (TKR—a common procedure, with which surgeons are generally very familiar. Consequently, we sought to investigate the potential role of PSI in guiding novice surgeons to perform the more technically demanding and less familiar lateral unicondylar knee replacement (LUKR).MethodsTwelve orthopaedic trainees naive to LUKR were instructed to perform the procedure according to a pre-operative plan. These were carried out on synthetic sawbones and were completed once with conventional instrumentation alone and once with the adjunct of PSI, allowing a comparison of the plan adherence achieved by the two sets of instrumentation.ResultsThere was a tendency for PSI to demonstrate improved plan adherence, though a statistically significant improvement was only seen in compound rotational error of the femoral implant (p = 0.004). PSI was, however, able to produce narrower standard deviations in the mean translational displacement of the femoral implant and also the mean rotational displacement of both implants, suggesting a higher degree of precision.ConclusionsOur study provides some evidence that PSI can improve the ability of novice surgeons to replicate a pre-operative plan, but our results suggest the need for larger-scale clinical studies to establish the role of PSI in this procedure.
Highlights
Patient-specific instrumentation (PSI) involves the production of individually designed and printed cutting guides, precisely matched to the patient’s own anatomy
Our study provides some evidence that PSI can improve the ability of novice surgeons to replicate a preoperative plan, but our results suggest the need for largerscale clinical studies to establish the role of PSI in this procedure
There was a trend for lower measures of mean compound error in the PSI group compared to conventional instrumentation (Fig. 5) in both the tibia and femur with respect to Swedish registry report [3, 14]
Summary
There was a trend for lower measures of mean compound error in the PSI group compared to conventional instrumentation (Fig. 5) in both the tibia and femur with respect to. The benefits of PSI have been questioned in the literature, but these conclusions have predominantly been based upon the assessment of experienced surgeons undertaking a common procedure, TKR [1]. Whilst this study reported superior survivorship and greater tibial plateau coverage with the custom implants, the study does not address the question of whether PSI is helpful in LUKR surgery. With respect to the use of PSI in medial UKR (MUKR) surgery, Trong et al [21] reported excellent implant alignment when comparing patients’ post-operative CTs to pre-operative plans. The degree of implant placement superiority demonstrated by PSI over conventional instrumentation was less than might have been expected This may be attributed to underpowering of the study. Our study would suggest PSI may have the potential to assist inexperienced surgeons undertaking the effective, but underutilised LUKR
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