scholarly journals Acute Perioperative Comparison of Patient-Specific Instrumentation versus Conventional Instrumentation Utilization during Bilateral Total Knee Arthroplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jerrod A. Steimle ◽  
Michael T. Groover ◽  
Brad A. Webb ◽  
Brian J. Ceccarelli
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Bilateral Total Knee Arthroplasty ◽  
Discharge Disposition ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition. A total of 49 patients with standard instrumentation and 31 patients with patient-specific instrumentation were retrospectively reviewed in a two-year period at one facility. At baseline, the groups were comparable with respect to age, ASA, BMI, and comorbid conditions. We analyzed data on operative time, blood loss, hemoglobin change, need for transfusion, pain medication use, length of stay, and discharge disposition. There was no statistically significant difference between groups in regards to these parameters. Patient-specific instrumentation in the setting of bilateral total knee arthroplasty did not provide any immediate perioperative benefit compared to conventional instrumentation.

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

2018 ◽  
Vol 32 (06) ◽  
pp. 483-489 ◽  
Author(s):  
Davide Cucchi ◽  
Alessandra Menon ◽  
Beatrice Zanini ◽  
Riccardo Compagnoni ◽  
Paolo Ferrua ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Significant Treatment ◽  
Longitudinal Measurements ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Conventional Instrumentation ◽  
Total Knee

AbstractPatient-specific instrumentation (PSI) may contribute to reduced blood loss related to total knee arthroplasty (TKA). The purpose of this study was to compare the estimated hemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation. Pre- and postoperative blood samples were collected from 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to preoperative Hb difference was calculated and RBC loss was estimated according to Sehat et al. A significant difference in Hb reduction in favor of the PSI group was registered on the last day of stay (p = 0.0084) and significant treatment effect (p = 0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements. This study demonstrated that PSI leads to a significant trend in earlier Hb regain. These promising results suggest a beneficial effect of PSI in blood loss reduction.

scholarly journals Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Leo Pauzenberger ◽  
Martin Munz ◽  
Georg Brandl ◽  
Julia K. Frank ◽  
Philipp R. Heuberer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Three Dimensional ◽  
Mobile Bearing ◽  
Patient Specific ◽  
Limb Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Abstract Background The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. Methods Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers. Results Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). Conclusions Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.

Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty

The Knee ◽  
2020 ◽  
Vol 27 (5) ◽  
pp. 1501-1509
Author(s):  
Jordan S. Broberg ◽  
Douglas D.R. Naudie ◽  
James L. Howard ◽  
Edward M. Vasarhelyi ◽  
Richard W. McCalden ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Contact Kinematics ◽  
Conventional Instrumentation ◽  
Total Knee

scholarly journals Blood Loss in Total Knee Arthroplasty

2016 ◽  
Vol 30 (05) ◽  
pp. 452-459 ◽  
Author(s):  
William Cundy ◽  
Annika Theodoulou ◽  
Chi Ling ◽  
Jeganath Krishnan ◽  
Christopher Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Computer Assisted ◽  
Routine Practice ◽  
Patient Specific Instrumentation ◽  
Transfusion Requirements ◽  
Total Knee

AbstractPatients undergoing total knee arthroplasty (TKA) have expected blood loss during and after surgery. The morbidity associated with blood loss and the burden of blood transfusions in adult arthroplasty necessitates preoperative optimization as routine practice. Current literature remains inconclusive on which TKA surgical instrumentation techniques are effective in minimizing perioperative blood loss, and consequently lower transfusion rates. The primary objective of this retrospective review, of a prospective randomized cohort study, was to compare surgical and patient factors, and their influence on blood loss and transfusions rates, between one type of patient-specific instrumentation (PSI), navigated computer-assisted surgery (CAS), and conventional TKA surgical techniques.A cohort of 128 matched patients (38 PSI, 44 CAS, 46 conventional surgeries) were compared. Preoperative factors analyzed included; age, gender, body mass index, preoperative hemoglobin (Hb) (g/L), international normalized ratio, use of anticoagulants and comorbid bleeding diathesis. Maximal Hb drop and transfusion requirements were compared on day 1 to 3. Perioperative factors collected included: surgical time, tourniquet time, drain output, in situ drain time, order of tibia or femoral cut, and intraoperative loss from suction.The three groups did not differ on the preoperative patient demographics examined. The difference between preoperative Hb and the lowest postoperative Hb readings did not differ between study groups (p = 0.39).There are no statistically significant differences in blood loss when comparing PSI versus CAS versus conventional TKA. Although emerging evidence on PSI is encouraging, the PSI technique for TKA does not result in reduced blood loss. The study was registered with ClinicalTrials.gov: NCT01145157.

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