The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

• DOI: 10.1007/s11999-015-4216-y
• Publication Date: 2015-02-24T15:58:19Z
• Authors: Denis Nam; Andrew Park; Jeffrey B. Stambough; Staci R. Johnson; Ryan M. Nunley; Robert L. Barrack
• Keywords: Sports medicine

Custom cutting guides (CCGs; sometimes called patient-specific instrumentation [PSI]) in total knee arthroplasty (TKA) use preoperative three-dimensional imaging to fabricate blocks specific a patient's native anatomy.The purposes of this study were determine if CCGs (1) improve clinical outcomes as measured by UCLA activity, SF-12, and Oxford scores; (2) coronal mechanical alignment versus standard guides.This was retrospective cohort patients undergoing primary TKA using the same cruciate-retaining, cemented system between January 2009 April 2012. Patients included they candidates for unilateral, cruciate-retaining met other prespecified criteria; allowed self-select either an MRI-based CCG procedure or TKA. Ninety-seven 120 (80.8%) 104 124 (83.9%, p = 0.5) with minimum 1-year followup available analysis. The first 95 (mean followup, 3 years; range, 1-4 years) 2 cohorts compared. goal all TKAs hip-knee-ankle (HKA) angle 0°. UCLA, scores collected preoperatively at each most recent visit. Postoperative, rotationally controlled scout CT scans used measure HKA alignment. Independent-sample t-tests chi-square tests comparisons value ≤ 0.05 considered significant.At no differences present two range motion (114° ± 14° 115° 15° standard, 0.7), (6 6 SF-12 physical (44 12 41 0.07), (39 9 37 10 0.1). No incremental improvement (1 4 1 0.5), (12 20 11 21, 0.8), (16 19 0.1) from postoperatively. There difference percentage outliers (23% 31% outside 0° 3°; 0.2) cohorts.At mean greater than years, fail demonstrate any advantages validated outcome scan benefit must be proven before continued implementation technology.Level III, study.