Department of Clinical Rehabilitation, Warsaw Medical University, Warsaw, Poland.
Department of Orthopedics and Rehabilitation, Warsaw Medical University, Warsaw, Poland.
Adv Exp Med Biol. 2018;1096:11-17. doi: 10.1007/5584_2018_193.
Alignment of the prosthesis is one of the most significant factors that affect the long-term clinical outcome following total knee arthroplasty (TKA). There is conflicting evidence whether patient-specific instrumentation (PSI) for TKA improves the component position compared to standard instrumentation. This study aimed to compare the rotational alignment of the femoral and tibial components in TKA patients when performed with either conventional or PSI. Sixty patients with primary knee osteoarthritis were randomly divided into two groups treated surgically with TKA: one with conventional instrumentation and the other with the Visionaire PSI system (Smith and Nephew, Memphis, TN). Computerized tomography (CT) and X-ray imaging were performed preoperatively and 12 weeks after surgery. The rotational alignment of the femoral and tibial component in all patients was assessed postsurgically using CT imaging according to the Berger protocol. Both groups were clinically assessed in a blinded fashion using the Knee Society Score (KSS) and a visual analog scale (VAS). Fifty-eight patients were prospectively assessed. The mean postsurgical follow-up was 3.0 ± 0.4 months. CT images did not reveal any significant improvement in the rotational alignment of the implant components between the groups. X-rays revealed a significant improvement in the deviation from the optimal alignment range of the femoral component in the coronal plane in both groups. Patients operated with Visionaire PSI assistance had poorer functional outcomes. We conclude that there were no improvements in clinical outcomes or knee component alignment in patients treated with PSI compared with those treated with standard instruments. In addition, clinical and functional assessment showed inferior results in terms of KSS and VAS scores at the midterm follow-up in patients treated with PSI.
假体的对线是影响全膝关节置换术（TKA）长期临床效果的最重要因素之一。有证据表明，与标准器械相比，TKA 患者专用器械（PSI）是否能改善假体位置存在争议。本研究旨在比较使用传统器械和 PSI 行 TKA 时股骨和胫骨假体的旋转对线。60 例原发性膝关节骨关节炎患者随机分为两组，分别采用传统器械和 Visionaire PSI 系统（Smith and Nephew，Memphis，TN）行 TKA 治疗。所有患者均在术前和术后 12 周进行计算机断层扫描（CT）和 X 线成像。术后根据 Berger 方案使用 CT 成像评估所有患者股骨和胫骨假体的旋转对线。两组均采用膝关节学会评分（KSS）和视觉模拟评分（VAS）进行盲法临床评估。58 例患者进行了前瞻性评估。平均术后随访 3.0±0.4 个月。CT 图像未显示两组之间假体组件的旋转对线有任何显著改善。X 射线显示两组股骨假体在冠状面的最佳对线偏差均有显著改善。接受 Visionaire PSI 辅助治疗的患者功能结局较差。我们得出结论，与使用标准器械相比，PSI 治疗的患者在临床结局或膝关节假体对线方面没有改善。此外，在中期随访时，PSI 治疗患者的 KSS 和 VAS 评分在临床和功能评估方面显示出较差的结果。
