Patient satisfaction - A comparison between patient-specific implants and conventional total knee arthroplasty

Background: The volume of total knee arthroplasty procedures is growing rapidly and, correspondingly, it is expected that the volume of revision procedures will grow rapidly as well. Revision surgery is most successful when adequate bone remains on both the tibia and femur to allow for the least invasive revision. We hypothesized that total knee arthroplasty with a patient-specific implant would result in significant bone preservation as compared to standard total knee arthroplasty with “off-the-shelf” implants. Methods: We evaluated 100 total knee arthroplasties which utilized patient-specific implants, versus 37 standard posterior stabilized and 32 standard posterior cruciate retaining total knee arthroplasties. Bone resection was quantified utilizing intra-operative measurements of actual resected bone. Additionally we performed a virtual, CAD-based analysis of resections via CT imaging on 15 knees. Findings: We found that patients had significantly less bone resected in all zones measured, on both the femur and tibia, when patient-specific implants with patient-specific jigs were used. When assessed volumetrically with CAD imaging, standard implants resected 12-49% more bone than did patient-specific implants, depending on the size of the implant utilized. Interpretations: Utilizing patient-specific implants in total knee arthroplasty results in significant bone sparing as compared to standard total knee arthroplasty. This has the potential for less invasive revision surgery in the future, possibly obviating the need for dedicated revision implants or augments and other bone substituting devices.

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

Technology and Health Care ◽

10.3233/thc-171167 ◽

2018 ◽

Vol 26 (3) ◽

pp. 523-528 ◽

Cited By ~ 3

Author(s):

Antonio Klasan ◽

Philipp Dworschak ◽

Thomas J. Heyse ◽

Matthias Lahner ◽

Dominik Malcherczyk ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Patient Specific Instruments ◽

Total Knee ◽

Conventional Total Knee Arthroplasty

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The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-013-2638-1 ◽

2013 ◽

Vol 22 (3) ◽

pp. 630-635 ◽

Cited By ~ 56

Author(s):

Jerry Yongqiang Chen ◽

Seng Jin Yeo ◽

Andy Khye Soon Yew ◽

Darren Keng Jin Tay ◽

Shi-Lu Chia ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Total Knee ◽

Conventional Total Knee Arthroplasty

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The Use of Customized Total Knee Arthroplasty Implants to Increase Efficiency in the Operating Room and Improve Patient Outc

Medical Research Archives ◽

10.18103/mra.v9i7.2474 ◽

2021 ◽

Vol 9 (7) ◽

Author(s):

Raj Sinha

Keyword(s):

Total Knee Arthroplasty ◽

Operating Room ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Knee Kinematics ◽

Anatomic Reconstruction ◽

Patient Specific ◽

Patient Specific Implants ◽

Patient Reported ◽

Total Knee

Operating room efficiency during surgical procedures saves time and money, reduces waste of hospital resources and improves staff morale. Surgical efficiency in orthopaedic surgery can decrease medical complications, such as periprosthetic infection and venous thromboembolic disease, but also must be associated with equivalent or improved longer term patient reported outcomes. In total knee arthroplasty, the instruments used for bone preparation are excessive in number, are frequently redundant, and rely upon achieving average alignment and rotational parameters. As a result, approximately 15-25% of patients report dissatisfaction with their knee reconstructions. Patient specific customized instruments and patient specific implants improve intraoperative efficiency by reducing surgical steps and eliminating redundant steps. Further, because the customized instruments and implants provide anatomic reconstruction of each individual patient, patient reported outcomes have been higher. Additional demonstrated benefits include improved knee alignment and knee kinematics. This paper addresses the various sources of operating room inefficiency, provides suggestions to overcome them, and discusses the first decade of experience with the customized guides for customized implants as a method to improve efficiency.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

The Journal of Hip Surgery ◽

10.1055/s-0040-1712523 ◽

2020 ◽

Vol 04 (02) ◽

pp. 084-089

Author(s):

Vivek Singh ◽

Stephen Zak ◽

Ran Schwarzkopf ◽

Roy Davidovitch

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Demographic Data ◽

Demographic Differences ◽

Total Hip ◽

Forgotten Joint Score ◽

Total Knee

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p < 0.001), 12 months (66.00 vs. 43.57; p < 0.001), and 21 months (73.45 vs. 47.22; p < 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

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Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1713353 ◽

2020 ◽

Author(s):

Stephen Thomas ◽

Ankur Patel ◽

Corey Patrick ◽

Gary Delhougne

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Hospital Cost ◽

Readmission Rate ◽

Hospital Costs ◽

Patient Specific ◽

P Value ◽

Total Hospital Cost ◽

Total Hospital ◽

Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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Comparison of Radiological, Clinical, Functional Outcomes Between Anatomically Aligned Total Knee Arthroplasty and Conventional Total Knee Arthroplasty

Case Medical Research ◽

10.31525/ct1-nct04183985 ◽

2019 ◽

Author(s):

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Functional Outcomes ◽

Total Knee ◽

Conventional Total Knee Arthroplasty

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The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996632 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199663

Author(s):

Mustafa Kaçmaz ◽

Zeynep Yüksel Turhan

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Nerve Block ◽

Knee Arthroplasty ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Adductor Canal Block ◽

Adductor Canal ◽

Significant Difference ◽

Total Knee

Introduction: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not. Methods: A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB. Results: Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05). Discussion: When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction. Conclusion: We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

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