Patient-specific Instrumentation Research Articles

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty: A systematic review and meta-analysis.

Over the past years, patient specific instrumentation (PSI) for total knee arthroplasty (TKA) has been implemented and routinely used. No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation (CI) for TKA. To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA. A literature search was performed in healthcare, economical healthcare, and medical databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, EconLit). It was conducted in April 2021 and again in January 2022. Relevant literature included randomised controlled trials, retrospective studies, prospective studies, observational studies, and case control studies. All studies were assessed on methodological quality. Relevant outcomes included incremental cost-effectiveness ratio, quality-adjusted life years, total costs, imaging costs, production costs, sterilization associated costs, surgery duration costs and readmission rate costs. All eligible studies were assessed for risk of bias. Meta-analysis was performed for outcomes with sufficient data. Thirty-two studies were included into the systematic review. Two were included in the meta-analysis. 3994 PSI TKAs and 13267 CI TKAs were included in the sample size. The methodological quality of the included studies, based on Consensus on Health Economic Criteria-scores and risk of bias, ranged from average to good. PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case. PSI TKA costs more compared to CI TKA when considering imaging and production costs. Considering total costs per patient case, PSI TKA is more expensive in comparison to CI TKA. Meta-analysis comparing total costs for PSI TKA, and CI TKA showed a significant higher cost for PSI TKA. Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation. Total costs per patient case are increased for PSI TKA when compared to CI TKA.

Osteotomies around the knee: preoperative planning using CT-based three-dimensional analysis, patient-specific cutting and reduction guides

The goal of osteotomy is either to restore pretraumatic anatomic conditions or to shift the load to less affected compartments. Indications for computer-assisted 3D analysis and the use of patient-specific osteotomy and reduction guides include "simple" deformities and, in particular, multidimensional complex (especially posttraumatic) deformities. General contraindications for performing acomputed tomography (CT) scan or for an open approach for performing the surgery. Based on CT examinations of the affected and, if necessary, the contralateral healthy extremity as ahealthy template (including hip, knee, and ankle joints), 3D computer models are generated, which are used for 3D analysis of the deformity as well as for calculation of the correction parameters. For the exact and simplified intraoperative implementation of the preoperative plan, individualized guides for the osteotomy and the reduction are produced by 3D printing. Partial weight-bearing from the first postoperative day. Increasing load after the first x‑ray control 6weeks postoperatively. No limitation of the range of motion. There are several studies that have analyzed the accuracy of the implementation of the planned correction for corrective osteotomies around the knee joint with the use of patient-specific instruments with promising results.

Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

A 69-year-old woman developed a painful ankle fusion nonunion and underwent conversion to a total ankle replacement. Preoperative navigation was performed using a computed tomography scan and computer modeling system to develop patient-specific instrumentation and surgery guides. We described the navigation process of a fixed-bearing, computer-guided total ankle implant when performing an ankle arthrodesis takedown due to symptomatic nonunion and converting to a total ankle arthroplasty. The use of this technology is relatively new, and, in this case, preoperative navigation allowed for precise implant planning while accounting for the osseous deformities from previous implants, which already fixated the ankle joint. Level of Evidence: Level IV.

Integration of Square Fiducial Markers in Patient-Specific Instrumentation and Their Applicability in Knee Surgery.

Computer technologies play a crucial role in orthopaedic surgery and are essential in personalising different treatments. Recent advances allow the usage of augmented reality (AR) for many orthopaedic procedures, which include different types of knee surgery. AR assigns the interaction between virtual environments and the physical world, allowing both to intermingle (AR superimposes information on real objects in real-time) through an optical device and allows personalising different processes for each patient. This article aims to describe the integration of fiducial markers in planning knee surgeries and to perform a narrative description of the latest publications on AR applications in knee surgery. Augmented reality-assisted knee surgery is an emerging set of techniques that can increase accuracy, efficiency, and safety and decrease the radiation exposure (in some surgical procedures, such as osteotomies) of other conventional methods. Initial clinical experience with AR projection based on ArUco-type artificial marker sensors has shown promising results and received positive operator feedback. Once initial clinical safety and efficacy have been demonstrated, the continued experience should be studied to validate this technology and generate further innovation in this rapidly evolving field.

Guiding prosthetic femoral version using 3D-printed patient-specific instrumentation (PSI): a pilot study

BackgroundImplantation of the femoral component with suboptimal version is associated with instability of the reconstructed hip joint. High variability of Prosthetic Femoral Version (PFV) has been reported in primary Total Hip Arthroplasty (THA). Three-dimensional (3D) Patient-Specific Instrumentation (PSI) has been recently developed and may assist in delivering a PFV within the intended range.We performed a pilot study to better understand whether the intra-operative use of a novel PSI guide, designed to deliver a PFV of 20°, results in the target range of PFV in primary cemented THA.MethodsWe analysed post-operative Computed-Tomography (CT) data of two groups of patients who underwent primary cemented THA through posterior approach; 1. A group of 11 patients (11 hips) for which the surgeon used an intra-operative 3D-printed stem positioning guide (experimental) 2. A group of 24 patients (25 hips) for which the surgeon did not use the guide (control). The surgeon aimed for a PFV of 20°, and therefore the guide was designed to indicate the angle at which the stem was positioned intra-operatively. PFV angles were measured using the post-operative 3D-CT models of the proximal femurs and prosthetic components in both groups. Our primary objective was to compare the PFV in both groups. Our secondary objective was to evaluate the clinical outcome.ResultsMean (± SD) values for the PFV was 21.3° (± 4.6°) and 24.6° (± 8.2°) for the experimental and control groups respectively. In the control group, 20% of the patients reported a PFV outside the intended range of 10° to 30° anteversion. In the experimental group, this percentage dropped to 0%. Satisfactory clinical outcome was recorded in both groups.ConclusionThe intra-operative use of a PSI PFV guide helped the surgeon avoid suboptimal PFV in primary cemented THA. Further studies are needed to evaluate if the PSI guide directly contributes to a better clinical outcome.

Correcting for distal femoral asymmetry is necessary to determine postoperative alignment deviations from planned alignment of the femoral component

BackgroundOne method for assessing the accuracy of manual, patient-specific, navigational, and robotic-assisted total knee arthroplasty (TKA) instrumentation is to use a post-operative computer tomogram and determine the deviation of the femoral component alignment relative to the planned alignment in the native (i.e. healthy) contralateral distal femoral epiphysis. However, side-to-side asymmetry might introduce errors which inflate alignment deviations. This study quantified asymmetry in the distal femoral epiphysis. MethodsHigh resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limb specimens of 13 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D femur models. Asymmetry was quantified by differences in positions and orientations required to shape-match the distal epiphysis of the mirror 3D femur model to the distal epiphysis of the contralateral 3D femur model. ResultsAsymmetry was due to random rather than systematic differences. Random differences (i.e. standard deviations) in proximal–distal (P-D) and anterior-posterior (A-P) positions were 1.1 mm and in varus-valgus (V-V) and internal-external (I-E) orientations were 0.9° and 1.3°, respectively. These represented substantial relative errors of up to 50 % in previously reported overall alignment deviations. ConclusionsAlthough small in an absolute sense, asymmetry of the distal femur epiphysis introduced substantial relative errors when assessing accuracy of femoral component alignment in TKA. When post-operative computer tomograms are used to assess the accuracy of manual, patient specific, navigational, and robotic-assisted TKA instrumentation, the overall deviation should be corrected for asymmetry to better indicate the accuracy of the surgical technique.

Quantifying 30 Years of Technological Innovation in Total Hip Arthroplasty

AbstractTechnological innovation in total hip arthroplasty (THA) is a critical component of health care delivery for improving patient outcomes. Analyzing the content of patents and trends in their activity over time can leverage insight into innovations in THA; however, these investigations remain underutilized. We aimed to quantify patent activity and relative growth pertaining to technologies in THA over a 30-year period. A query for patents relating to “hip replacement” or “hip arthroplasty” between 1989 and 2019 using an open-source patent database yielded 24,071 unique patents for analysis. These were grouped into 12 independent technology clusters using Cooperative Patent Classification codes. Annual patent activity for each cluster was normalized with a validated formula to control for exponential growth. The 5-, 10-, and 30-year compound annual growth rates (CAGR) for each cluster were quantified and compared between clusters. Annual cumulative patent activity increased from 151 patents in 1989 to 1,182 patents in 2019, representing a 682.8% increase. The largest technology clusters concerned “drugs” (n = 6,429 patents), “instruments” (n = 4,014 patents), “materials” (n = 2,037 patents), and “components” (n = 1,946 patents). One-half of the identified clusters concerned developments in technology-assisted THA (patient-specific instrumentation, navigation, robotics, design/manufacturing, instruments, and computer modeling). The most rapidly growing technology within the past 5, 10, and 30 years was robotics (CAGR = 15.82%, 20.11%, and 9.50%, respectively). Within the past 5- and 10-year trial prostheses (CAGR = 10.76%) and design/manufacturing processes (CAGR = 10.27%), computer modeling (CAGR = 12.91%) and navigation (CAGR = 11.25%) were among the most rapidly growing clusters, respectively. The majority of patents pertaining to THA over the past 30 years have concerned developments in drugs, instruments, materials, and components. Within the past 10-years, substantial growth has been observed in patent domains related to technology-assisted THA. Monitoring of emerging technologies through patent metrics may provide valuable information for regulatory bodies and assess progress in the field of THA. This is a cross-sectional study with level of evidence IV.

PRECLINICAL TESTING OF A CUSTOM-MADE PERSONALIZED HIGH TIBIAL OSTEOTOMY SYSTEM FOLLOWING THE ‘IDEAL’ FRAMEWORK: ACCURACY OF ANATOMICAL CORRECTION USING 3D IMAGING

High tibial osteotomy (HTO) is an effective surgical treatment for isolated medial compartment knee osteoarthritis; however, widespread adoption is limited due to difficulty in achieving the planned correction, and patient dissatisfaction due to soft tissue irritation. A new HTO system – Tailored Osteotomy Knee Alignment (TOKA®, 3D Metal Printing Ltd, Bath, UK) could potentially address these barriers having a custom titanium plate and titanium surgical guides featuring a unique mechanism for precise osteotomy opening as well as saw cutting and drilling guides. The aim of this study was to assess the accuracy of this novel HTO system using cadaveric specimens; a preclinical testing stage ahead of first-in-human surgery according to the ‘IDEAL-D’ framework for device innovation.Local ethics committee approval was obtained. The novel opening wedge HTO procedure was performed on eight cadaver leg specimens. Whole lower limb CT scans pre- and post-operatively provided geometrical assessment quantifying the discrepancy between pre-planned and post-operative measurements for key variables: the gap opening angle and the patient specific surgical instrumentation positioning and rotation - assessed using the implanted plate.The average discrepancy between the pre-operative plan and the post-operative osteotomy correction angle was: 0.0 ± 0.2°. The R2 value for the regression correlation was 0.95.The average error in implant positioning was −0.4 ± 4.3 mm, −2.6 ± 3.4 mm and 3.1 ± 1.7° vertically, horizontally, and rotationally respectively.This novel HTO surgery has greater accuracy and smaller variability in correction angle achieved compared to that reported for conventional or other patient specific methods with published data available. This system could potentially improve the accuracy and reliability of osteotomy correction angles achieved surgically.

Quantification of Malalignment and Corrective Osteotomies in Patients With Malunion After Elastic Stable Intramedullary Nailing of Pediatric Forearm Fractures

This study looked at postoperative malunion with restricted function after elastic stable intramedullary nailing (ESIN) in pediatric patients in their childhood or adolescence. The primary objective was to compare the magnitude of the osseous malposition to the healthy opposite side. Second, these individuals were treated with patient-specific surgical instrumentation, and functional outcomes were documented. Patients under the age of 18 at the time of a corrective osteotomy due to a forearm malunion after initial ESIN treatment were included in this study. The healthy contralateral side was used as a reference for preoperative analysis and planning of the osteotomy. Osteotomies were performed using patient-specific guides and the direction and extent of the malunion were compared to the change in range of motion (ROM) after the operation. Fifteen patients met the inclusion criteria at three years after initial ESIN placement, with the most pronounced malposition in the rotational axis. The postoperative function significantly improved by 12° (pre-op: 60°±17; post-op: 72°±10) of pronation and 33° (pre-op: 43°±26; post-op: 76°±13) of supination. There was no correlation between the amount and direction of malformation and the change in ROM. The most noticeable malunion after forearm fractures treated with the ESIN technique is in the rotational direction. Patient-specific corrective osteotomy of pediatric forearm malunion following forearm fracture fixation with ESIN achieves significant improvement in forearm range of motion. The findings are clinically relevant since forearm fractures are the most common pediatric fracture, affecting a large number of patients who can benefit from the findings of this study. It has the potential to raise awareness of the significance of the accurate rotational component of intraoperative bone alignment in the ESIN procedure.

The partial talus replacement (PTR) – An alternative treatment for severe osteochondral lesions of the talus utilizing a custom 3D printed talar hemiarthroplasty implant: A case report and technique guide

Large osteochondral lesions of the talus can lead to severe pain and disability. Various surgical interventions have been described in published literature. Customized implants developed through additive manufacturing are increasing in popularity with favorable results within foot and ankle surgery. This case study reports a 52-year-old male who has a history of failed prior surgical interventions with severe left ankle pain associated with a large osteochondral lesion of the talus. The patient underwent resection of the diseased bone with the aid of patient specific instrumentation followed by implantation of a custom 3D printed partial talus implant to resurface the talar dome. At a final follow up of 24 months, the patient continued to experience significant improvement in functional outcomes without radiographic evidence of implant complications.

Restoring tibial obliquity for kinematic alignment in total knee arthroplasty: conventional versus patient-specific instrumentation

Introduction In total knee arthroplasty (TKA), tibial obliquity-restoration using kinematic alignment (KA) poses a major difference to conventional mechanical alignment. This study aimed at analysing the accuracy of conventional instrumentation (CI) versus patient-specific instrumentation (PSI) to restore anatomic tibial obliquity measured by the medial proximal tibial angle (MPTA) on conventional X-rays.Materials and Methods One-hundred patients were randomized to receive CI (n = 50) or PSI (n = 50) for TKA. Further 100 patients received CI without randomisation, resulting in 200 patients in total (127 women, mean age: 70.7 (range: 48–90 years). Pre- and postoperative X-rays were measured twice by two observers with a 2-week break in-between. Inter- and intraclass correlations were calculated and postoperative tibial obliquity compared to preoperative anatomy.ResultsIn 150 patients with CI, no case with tibial obliquity-deviation greater than 2° was found, whilst 21.3% (n = 32) and 0.7% (n = 1) of cases and had a deviation of 0°–1°, and 1°–2°, respectively. In the remaining 78.0% (n = 117), tibial obliquity was restored. In 50 patients with PSI, no single case with a deviation greater than 1° was found. Sixty percent (n = 30) had a deviation of 0°–1°. In the remaining 40.0% (n = 20), no deviation from preoperative measurements was found. Consequently, CI resulted in a significantly smaller change in tibial obliquity from preoperative to postoperative than PSI (p < 0.001). Inter- and intra-class correlations showed a substantial agreement (any ICC > 0.90).ConclusionBoth conventional and patient-specific instrumentation revealed adequate results with respect to restoring tibial obliquity in kinematically aligned TKA, with conventional instrumentation achieving superior results.

Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques.

A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate differences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line. We performed a retrospective radiological analysis of pre- and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-specific instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients' radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical significance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses). Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any differences in the accuracy of medial joint line reconstruction (< 2mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1mm vs. 1.5mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001). Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques. III.

Review of novel shoulder arthroplasty planning technologies and potential conflicts of interest

Preoperative planning software is intended to improve surgical planning and patient outcomes in shoulder arthroplasty. Three-dimensional computed topography (CT) scans allow for a more accurate depiction of glenoid erosion than traditional 2-dimensional CT scans. Patient-specific instrumentation and computer-assisted navigation are newer technologies that were invented to improve implant positioning. The literature on these newer technologies is often published by authors with conflict of interest. In this article, we review perioperative planning software, 3-dimensional CT scans, patient-specific instrumentation, and computer-assisted navigation with a primary goal to evaluate if these novel technologies are improving implant positioning, patient specific outcomes, and cost effectiveness while evaluating conflict of interest in the published literature.

Patient-Specific Instruments for Resection and Reconstruction of Osteoblastoma in the Talus

Osteoblastoma of the talus is a rare and challenging pathology both to diagnose and treat successfully. Treatment of an inadequate osteoblastoma resection is usually a wide resection, however, achieving the desired margins in the foot and ankle bones can lead to complications such as fractures or joint loss. We present a case of an incomplete talar neck Osteoblastoma resection and a novel technique that was followed for 3 years after surgery. Level of Evidence: Diagnostic Level V—technique description. See Instructions for Authors for a complete description of levels of evidence.

Patient Specific Instruments and Patient Individual Implants—A Narrative Review

Joint arthroplasties are one of the most frequently performed standard operations worldwide. Patient individual instruments and patient individual implants represent an innovation that must prove its usefulness in further studies. However, promising results are emerging. Those implants seem to be a benefit especially in revision situations. Most experience is available in the field of knee and hip arthroplasty. Patient-specific instruments for the shoulder and upper ankle are much less common. Patient individual implants combine individual cutting blocks and implants, while patient individual instruments solely use individual cutting blocks in combination with off-the-shelf implants. This review summarizes the current data regarding the implantation of individual implants and the use of individual instruments.

Three-dimensional-printed patient-specific instrumentation is an accurate tool to reproduce femoral bone tunnels in multiple-ligament knee injuries

PurposeMultiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Currently, no specific template guide to reproduce these angulations has been reported in the literature, and the success of the technique still depends on the experience of the surgeon. The aim of this study is to analyze the accuracy and reliability of 3D-printed patient-specific instrumentation (PSI) for lateral and medial anatomical knee reconstructions.MethodsTen cadaveric knees were scanned by computed tomography (CT). Using specific computer software, anatomical femoral attachments were identified: (1) on the lateral side the lateral collateral ligament (LCL) and the popliteal tendon (PT) and (2) on the medial side the medial collateral ligament (MCL) and the posterior oblique ligament (POL). Four bone tunnels were planned for each knee, and PSI with different directions were designed as templates to reproduce the planned tunnels during surgery. Twenty 3D-printed PSI were used: ten were tailored to the medial side for reconstructing MCL and POL tunnels, and the other ten were tailored to the lateral side for reconstructing LCL and PT tunnels. Postoperative CT scans were made for each cadaveric knee. The accuracy of the use of 3D-printed PSI was assessed by superimposing post-operative CT images onto pre-operative images and analyzing the deviation of tunnels performed based on the planning, specifically the entry point and the angular deviations.ResultsThe median entry point deviations for the tunnels were as follows: LCL tunnel, 1.88 mm (interquartile range (IQR) 2.2 mm); PT tunnel, 2.93 mm (IQR 1.17 mm); MCL tunnel, 1.93 mm (IQR 4.26 mm); and POL tunnel, 2.16 mm (IQR 2.39). The median angular deviations for the tunnels were as follows: LCL tunnel, 2.42° (IQR 6.49°); PT tunnel, 4.15° (IQR 6.68); MCL tunnel, 4.50° (IQR 6.34°); and POL tunnel, 4.69° (IQR 3.1°). No statistically significant differences were found in either the entry point or the angular deviation among the different bone tunnels.ConclusionThe use of 3D-printed PSI for lateral and medial anatomical knee reconstructions provides accurate and reproducible results and may be a promising tool for use in clinical practice.

The efficacy and safety of patient-specific instrumentation in primary total knee replacement: a systematic review and meta-analysis

ABSTRACT Introduction Patient-specific instrumentation (PSI) for primary total knee arthroplasty (TKA) surgery has been shown to increase accuracy of component positioning. However, it is unclear whether this also translates to actual benefits for patients in terms of better outcomes (efficacy) or less complications such as revisions (safety). We therefore systematically reviewed the literature to determine the efficacy and safety of PSI in primary TKA. Methods Randomized controlled trials comparing PSI to non-PSI in primary TKA were included. A random effects model was used with meta-regression in case of heterogeneity. Results Forty-three studies were included with a total of 1816 TKA in the PSI group and 1887 TKA in the control group. There were no clinically relevant differences between the PSI-group and non-PSI group regarding all outcomes. There was considerable heterogeneity: meta-regression analyses showed that the year the study was published was an important effect modifier. Early publications tended to show a positive effect for PSI compared to non-PSI TKA, whereas later studies found the opposite. Conclusion Based on evidence of moderate certainty, our study suggested that there were no clinically relevant differences in efficacy and safety between patients treated with PSI TKA and patients treated with non-PSI TKA.

Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in a population with small glenoid dimensions

PurposeGlenoid component loosening is a potential complication of reverse total shoulder arthroplasty (rTSA), occurring in part due to lack of adequate screw purchase in quality scapular bone stock. This study was to determine the efficacy of a surgeon-designed, 3D-printed patient-specific instrumentation (PSI) compared to conventional instrumentation (CI) in achieving longer superior and inferior screw lengths for glenoid component fixation.MethodsA multi-centre retrospective analysis of patients who underwent rTSA between 2015 and 2020. Lengths of the superior and inferior locking screws inserted for fixation of the glenoid baseplate component were recorded and compared according to whether patients received PSI or CI. Secondary outcomes included operative duration and incidence of complications requiring revision surgery.ResultsSeventy-three patients (31 PSI vs. 42 CI) were analysed. Average glenoid diameter was 24.5 mm (SD: 3.1) and 81% of patients had smaller glenoid dimensions compared to the baseplate itself. PSI produced significantly longer superior (44.7 vs. 30.7 mm; P < 0.001) and inferior (43.0 vs. 31 mm; P < 0.001) mean screw lengths, as compared to CI. A greater proportion of maximal screw lengths for the given rTSA construct (48 mm) were observed in the PSI group (71.9% vs. 11.9% superior, 59.4% vs. 11.9% inferior). Operative duration was not statistically significantly different between the PSI and CI groups (150 min vs. 169 min, respectively; P = 0.229). No patients had radiographic loosening of the glenoid component with an average of 2-year follow-up.ConclusionPSI facilitates longer superior and inferior screw placement in the fixation of the glenoid component for rTSA. With sufficient training, PSI can be designed and implemented by surgeons themselves.

Insights and trends review: the role of three-dimensional technology in upper extremity surgery.

The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.

Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty: Results from a Large Integrated Health-Care System.

This was a retrospective cohort study conducted using data from an integrated health-care system's shoulder arthroplasty registry. Adult patients who underwent primary elective anatomic or reverse total shoulder arthroplasty (2015 to 2020) were identified. Preoperative planning technologies were identified as (1) a computed tomography (CT) scan and (2) patient-specific instrumentation (PSI). Multivariable Cox regression and logistic regression were used to compare the risk of aseptic revision and 90-day adverse events, respectively, between procedures for which technologies were and were not used. The study sample included 8,117 procedures (in 7,372 patients) with an average follow-up of 2.9 years (maximum, 6 years). No reduction in the risk of aseptic revision was observed for patients having either preoperative CT scans (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.87 to 1.72) or PSI (HR = 1.44; 95% CI = 0.71 to 2.92). Patients having CT scans had a lower likelihood of 90-day emergency department visits (odds ratio [OR] = 0.84; 95% CI = 0.73 to 0.97) but a higher likelihood of 90-day venous thromboembolic events (OR = 1.79; 95% CI = 1.18 to 2.74). Patients with PSI use had a higher likelihood of 90-day deep infection (OR = 7.74; 95% CI = 1.11 to 53.94). We found no reduction in the risk of aseptic revision with the use of these technologies. Patients having CT scans and PSI use had a higher likelihood of venous thromboembolism and deep infection, respectively. Ongoing research with extended follow-up is being conducted to further examine the effects of these technologies on patient outcomes. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.