Patient-specific instruments' routine use over conventional total knee arthroplasty remains inconclusive: Analysis of 961 cases.

Abstract

An increasing demand for total knee arthroplasty (TKA) has pushed innovations in the industry and created a promising new technique called patient specific instruments (PSI). Early reports had promising results such as reducing operative time, cost, and improved alignment. More recent reports are conflicting. We aimed to evaluate bleeding, operative time, complication rates, and in-hospital stay. A monocentric retrospective analysis was performed on a total of 961 patients that met inclusion criteria. Four different TKA Systems, two of which were performed using conventional instrumentation (CI) (n= 768) and two with PSI (n= 193) were trialed under the same conditions by three senior surgeons. Operative time, complications, bleeding, range of motion, and length of stay were analyzed. There was no difference in operative time (p= 0.991) and length of hospital stay (p= 0.371) between PSI and CI approaches. Complication rates were lower in the PSI group. CI patients showed less non-compensated blood loss (p< 0.001) but required more transfusions (5.8% vs. 1.5%, p= 0.014). There was no difference in duration of surgery, length of stay, and total blood loss when performing TKA with PSI or CI. There were fewer complications in the PSI group. It remains debatable whether these findings justify routine use of PSI in TKA.