Evidence map›Paper›PMID 28698929›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018

Favourable alignment outcomes with MRI-based patient-specific instruments in total knee arthroplasty.

Martijn G M Schotanus, Elke Thijs, Marion Heijmans, Rein Vos, Nanne P Kort

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 4 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

24 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  8. No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2018
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  19. A safe transition to a more personalized alignment in total knee arthroplasty: the importance of a "safe zone" concept.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022
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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.

Martijn G M SchotanusZuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands. martijnschotanus@hotmail.com.ORCID http://orcid.org/0000-0002-3975-6337
Elke ThijsZuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
Marion HeijmansZuyderland Academy, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
Rein VosDepartment of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands.
Nanne P KortZuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePatient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs.

methodsThis systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken.

resultsTwelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment.

conclusionThis systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI. LEVEL OF EVIDENCE: I.

Indexed as

Magnetic Resonance ImagingSurgery, Computer-AssistedArthroplasty, Replacement, KneeBone MalalignmentFemurHumansKnee JointKnee ProsthesisOsteoarthritis, KneeTibiaTreatment OutcomeAlignmentConventional instrumentsCTLong-leg standing radiographMeta-analysisMRIOutliersPatient-specific instruments, PSISystematic literature reviewTotal knee arthroplasty, TKA

Identifiers

PMID28698929

What OpenQuestion holds

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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.