Page 5 - OrthoFeed issue3 - Final
P. 5
Management
A review of patient specific instrumentation based
on predictive modelling in total knee arthroplasty
Dr. Rajeev Verma Evidence from literature
MS, Orthopedics and joint replacement surgeon A systematic review of 38 studies including a total of
3487 patients found that TKA-PSI does not improve
Manipal Hospital Dwarka, New Delhi patient-reported outcome measures, surgery time, and
complication rates as compared to standard TKA. [3]
TKA-PSI is found to decreases blood loss with a small
Introduction effect, which is not enough to reduce transfusion rate.
[3]
Patient specific instrumentation (PSI) is a modern
Literature does not suggest PSI techniques as a gold
technique in total knee arthroplasty (TKA) aiming to
standard in TKA, and therefore it cannot be
facilitate the implant of the prosthesis. [1]
recommended as technique in standard,
The customized cutting blocks of the PSI are generated uncomplicated primary TKA. [2]
from pre-operative three-dimensional model, using
computed tomography (CT) or magnetic resonance
Conclusion
imaging (MRI). [1]
Supporting literature is not strong enough to recommend
regular use of PSI. But, it is a great option for performing
Procedure “minimally invasive” surgeries required in-
Cases of deformities healed with a malalignment [2]
Preoperative 3D imaging is used to model the knee anatomy. [2]
Technically difficulties cases, such as those requiring
A personalized surgical plan is designed with respect to bone intra-medullar rods [2]
resection and component positioning and alignment. [2]
Cases where intra-medullary guides are
contraindicated [2]
The cutting blocks or pin guides are rendered [2]
Further studies are required to establish the safety
Custom cutting guides are pinned directly into place [2]
and utility of PSI in Indian scenario
A standard saw is used through the cutting slots [2]
References
Advantages 1. Mattei L, Pellegrino P, Calò M, Bistolfi A, Castoldi F. Patient
specific instrumentation in total knee arthroplasty: a state of the
Facilitate surgery with limited exposure. [2] art. Ann Transl Med. 2016;4(7):126. doi:10.21037/atm.2016.03.33
2. Batailler C, Swan J, Sappey Marinier E, Servien E, Lustig S.
No violation of intramedullary canals [2] New Technologies in Knee Arthroplasty: Current Concepts. J
Clin Med. 2020;10(1):47. Published 2020 Dec 25.
Decrease risk of fat embolus and blood loss [2] doi:10.3390/jcm10010047
Reproducible neutral postoperative alignment [1] 3. Kizaki, K., Shanmugaraj, A., Yamashita, F. et al. Total knee
arthroplasty using patient-specific instrumentation for
osteoarthritis of the knee: a meta-analysis. BMC Musculoskelet
Disord 20, 561 (2019). https://doi.org/10.1186/s12891-019-2940-2
Limitations
Do not aid in the performing of gap balancing or soft
tissue releases [2]
Tibial component rotation, implant fixation and
patellar preparation remain the responsibility of the
surgeon [2]
