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      A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement.

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          Abstract

          Patient-specific cutting guides (PSCGs) are designed to improve the accuracy of alignment of total knee replacement (TKR). We compared the accuracy of limb alignment and component positioning after TKR performed using PSCGs or conventional instrumentation. A total of 80 patients were randomised to undergo TKR with either of the different forms of instrumentation, and radiological outcomes and peri-operative factors such as operating time were assessed. No significant difference was observed between the groups in terms of tibiofemoral angle or femoral component alignment. Although the tibial component in the PSCGs group was measurably closer to neutral alignment than in the conventional group, the size of the difference was very small (89.8° (sd 1.2) vs 90.5° (sd 1.6); p = 0.030). This new technology slightly shortened the bone-cutting time by a mean of 3.6 minutes (p < 0.001) and the operating time by a mean 5.1 minutes (p = 0.019), without tangible differences in post-operative blood loss (p = 0.528) or need for blood transfusion (p = 0.789). This study demonstrated that both PSCGs and conventional instrumentation restore limb alignment and place the components with the similar accuracy. The minimal advantages of PSCGs in terms of consistency of alignment or operative time are unlikely to be clinically relevant.

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          Author and article information

          Journal
          Bone Joint J
          The bone & joint journal
          2049-4408
          2049-4394
          Mar 2013
          : 95-B
          : 3
          Affiliations
          [1 ] Siriraj Hospital, Department of Orthopaedic Surgery, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
          Article
          95-B/3/354
          10.1302/0301-620X.95B3.29903
          23450020
          3956ed92-8605-44d8-8dd0-2e0c5ddc12d2
          History

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