Evidence map›Paper›PMID 27249110›Full record

ReviewActa orthopaedica2016

Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty.

Henricus J T A M Huijbregts, Riaz J K Khan, Emma Sorensen, Daniel P Fick, Samantha Haebich

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Acta orthopaedica, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Henricus J T A M Huijbregtsa The Joint Studio, Hollywood Medical Centre , Nedlands ;
Riaz J K Khana The Joint Studio, Hollywood Medical Centre , Nedlands ;
Emma Sorensena The Joint Studio, Hollywood Medical Centre , Nedlands ;
Daniel P Ficka The Joint Studio, Hollywood Medical Centre , Nedlands ;
Samantha Haebicha The Joint Studio, Hollywood Medical Centre , Nedlands ;

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and purpose - Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) has been introduced to improve alignment and reduce outliers, increase efficiency, and reduce operation time. In order to improve our understanding of the outcomes of patient-specific instrumentation, we conducted a meta-analysis. Patients and methods - We identified randomized and quasi-randomized controlled trials (RCTs) comparing patient-specific and conventional instrumentation in TKA. Weighted mean differences and risk ratios were determined for radiographic accuracy, operation time, hospital stay, blood loss, number of surgical trays required, and patient-reported outcome measures. Results - 21 RCTs involving 1,587 TKAs were included. Patient-specific instrumentation resulted in slightly more accurate hip-knee-ankle axis (0.3°), coronal femoral alignment (0.3°, femoral flexion (0.9°), tibial slope (0.7°), and femoral component rotation (0.5°). The risk ratio of a coronal plane outlier (> 3° deviation of chosen target) for the tibial component was statistically significantly increased in the PSI group (RR =1.64). No significance was found for other radiographic measures. Operation time, blood loss, and transfusion rate were similar. Hospital stay was significantly shortened, by approximately 8 h, and the number of surgical trays used decreased by 4 in the PSI group. Knee Society scores and Oxford knee scores were similar. Interpretation - Patient-specific instrumentation does not result in clinically meaningful improvement in alignment, fewer outliers, or better early patient-reported outcome measures. Efficiency is improved by reducing the number of trays used, but PSI does not reduce operation time.

Indexed as

Arthroplasty, Replacement, KneeHumansKnee JointKnee ProsthesisOperative TimeOsteoarthritis, KneeProsthesis DesignRandomized Controlled Trials as TopicSurgery, Computer-AssistedTomography, X-Ray ComputedTreatment Outcome

Identifiers

PMID27249110
PMCPMC4967282

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.