Correlation of post-operative anterior knee pain in two different total knee arthroplasty techniques: the conventional instrumentation (CI) and the patient specific instrumentation (PSI).
Purpose: Evaluation of the clinical outcome, as assessed by the Visual Analogue Scale score and clinical questionnaires, in total knee arthroplasty undertaken with patient specific or conventional instrumentation.
Methods: This is a prospective comparative clinical study of 115 consecutive patients who underwent total knee arthroplasty in two different orthopedic centers. Patients were assessed using the 0-10 Visual Analog Scale in different activities, the Tegner -Lysholm Functional Score, the Knee Society Scores (KSS), measured preoperatively and at 3-6-12 months postoperatively.
Results: Both groups improved significantly over time on all score clinical outcomes. Statistically significant differences were observed between the two groups in the KSS knee score postoperatively at 6 and 12 months (p=0.007 and p=0.004 respectively), and in the Tegner- Lysholm score only at 6 months postoperatively (p=0.001), both in favour of patient specific intrumentation group. The mean KSS was 91.32±4.29 and 93.15±4.72 for the conventional and patient specific groups respectively at 12 months follow up (p=0.063). No statistically significant difference was found at 12 months between two groups when the visual analog scale was measured related to the activity of standing up from the sitting position (conventional group: 1.15±0.36 versus patient specific: 1.10±0.30, p=0.380).
Conclusion: We did not ﬁnd major signiﬁcant differences for pain scores, functional scores and clinical outcomes between the conventional instrumentation and the use of patient specific instrumentation for total knee replacement. The current literature does not suggest patient specific instrumentation techniques as a gold standard. Therefore, patient specific techniques cannot be recommended as a standard procedure and specially in order to minimize the anterior knee pain after total knee arthroplasty.
2. Van Jonbergen HP, Reuver JM, Mutsaerts EL, Poolman RW. Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22: 478-499
3. Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA. The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee Surg Sports Traumatol Arthrosc 2009; 17: 1211-1216
4. Breugem SJ, Haverkamp D. Anterior knee pain after a total knee arthroplasty: What can cause this pain? World J Orthop 2014; 5: 163-170
5. Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63
6. Kwon SK, Nguku L, Han CD, et al. Is electrocautery of patella useful in patella non-resurfacing total knee arthroplasty? A prospective randomized controlled study. J Arthroplasty 2015;30:2125-7
7. Chen K, Li G, Fu D, Yuan C, Zhang Q, Cai Z (2013) Patellar resurfacing versus non resurfacing in total knee arthroplasty a metaanalysis of randomized controlled trials.IntOrthop37(6):1075–1083
8. Fu Y, Wang G, Fu Q (2011) Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19(9):1460–1466
9. Patel K, Raut V (2011)Patella in total knee arthroplasty:to resurface or not to. A cohort study of staged bilateral total knee arthroplasty. Int Orthop 35(3):349–353
10. He JY, Jiang LS, Dai LY (2011). Is patellar resurfacing superior than non resurfacing in total knee arthroplasty? A meta-analysis of randomized trials. Knee 18(3):137–144
11. Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238
12. Correia J, Sieder M, Kendoff D, Citak M, Gehrke T, Klauser W, Haasper C (2012) Secondary patellar resurfacing after primary bicondylar knee arthroplasty did not meet patients’ expectations. Open Orthop J 6:414–418
13. Garcia RM, Kraay MJ, Goldberg VM (2010) Isolated resurfacing of the previously unresurfaced patella total knee arthroplasty. J Arthroplasty 25(5):754–758. doi:10.1016/j.arth.2009.06.01
14. Muñoz-Mahamud E, Popescu D, Nuñez E, Lozano LM, Nuñez M, Sastre S, Torner P, Segur JM, Maculé F (2011) Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(9):1467–1472
15. Muoneke HE, Khan AM, Giannikas KA, Hägglund E, Dunningham TH (2003) Secondary resurfacing of the patella for persistent anterior knee painafterprimarykneearthroplasty. J Bone Joint Surg Br 85(5):675–678
16. Camarda L, D’Arienzo A, Morello S, Peri G, Valentino B, D’Arienzo M (2015) Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg 99:11–18
17. Nam D, Mcarthur BA, Cross MB, Pearle AD, Mayman DJ, Haas SB (2012) Patient-specific instrumentation in total knee arthroplasty: a review. J Knee Surg 25:213–219
18. Alcelik I, Blomfield M, Öztürk C, Soni A, Charity R, Acornley A (2017) A comparison of short term radiological alignment outcomes of the patient specific and standard instrumentation for primary total knee arthroplasty: a systematic review and metaanalysis. Acta Orthop Traumatol Turc 51(3):215–222
19. Cavaignac E, Pailhé R, Laumond G, Murgier J, Reina N, Laffosse JM (2015) Evaluation of the accuracy of patient—specific cutting blocks for total knee arthroplasty: a meta-analysis. Int Orthop 39(8):1541–1552
20. Huijbregts HJTAM, Khan RJK, Sorensen E, Fick DP, Haebich S (2016) Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty. Acta Orthop 87(4):386–394
21. Jiang J, Kang X, Lin Q, Teng Y, An L, Ma J (2015) Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 38(4):e305
22. Mannan A, Smith TO, Sagar C, London NJ, Molitor PJ (2015) No demonstrable benefit for coronal alignment outcomes in psi knee arthroplasty: a systematic review and meta-analysis. Orthop Traumatol Surg Res 101(4):461–468
23. Qing-Meng Z, Ji-Ying C, Heng L, Wei C, Ming N, Zhen-Dong Z (2015) No evidence of superiority in reducing outliers of component alignment for patient-specific instrumentation for total knee arthroplasty: a systematic review. Orthop Surg 7(1):19–25
24. Russell R, Brown T, Huo M, Jones R (2014) Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg 27(06):501–504
25. Sharareh B, Schwarzkopf R (2015) Review article: patient-specific versus standard instrumentation for total knee arthroplasty. J Orthop Surg 23(1):100
26. Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX (2015) Patient-specific instrumentation does not improve accuracy in total knee arthroplasty. Orthopedics 38(3):178–188
27. Thienpont E, Schwab PE, Fennema P (2017) Efficacy of patientspecific instruments in total knee arthroplasty: a systematic review and meta-analysis. J Bone Jt Surg Am 99(6):521
28. Thienpont E, Schwab PE, Fennema P (2014) A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Jt J 410(6825):1052–1061
29. Voleti PB, Hamula MJ, Baldwin KD, Lee GC (2014) Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty 29(9):1709–1712
30. Gong S, Xu W, Wang R, Wang Z, Wang B, Han L, Chen G, (2019) Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty. KneeSurgSportsTraumatolArthrosc 27:1083–1095
31. Van Leeuwen, J, Snorrason F, Röhr S, No radiological and clinical advantages with patient-speciﬁc positioning guides in total knee replacement. Acta Orthopaedica 2018; 89 (1): 89–94
32. Boonen B, Schotanus M G, Kerens B, van der Weegen W, Hoekstra H J, Kort N P. No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively: A multicentre, double-blind, randomised controlled trial. Bone Joint J 2016; 98-B (7): 939-944.
33. Woolson S T, Harris A H, Wagner D W, Giori N J. Component alignment during total knee arthroplasty with use of standard or custom instrumentation: A randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 2014; 96 (5): 366-72
34. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications. Curr Rev Musculoskelet Med 2014; 7: 8995
35. Feller, J.A., Bartlett, R.J., Lang, D.M. Patellar resurfacing versus retention in total knee arthroplasty.J Bone Joint Surg (Br). 1996;78:226
36. Gupta, S., Augustine, A., Horey, L. et al, Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary? J Bone Joint Surg (Br). 2010;92:1259
37. Ranawat CS. History of total knee replacement. J South Orthop Assoc 2002; 11: 218-226
38. Becker R, Bonnin M, Hofmann S. The painful knee after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1409-1410
39. Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C. Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 2014; 38: 319-328
40. Shervin D, Pratt K, Healey T, et al. Anterior knee pain following primary total knee arthroplasty. World J Orthop. 2015;6:795–803
41. Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ. Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res 2006; 446: 45-50
42. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty 2014; 29: 1774-1778
43. Pietsch M, Hofmann S. Early revision for isolated internal malrotation of the femoral component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1057-1063
44. Lakstein D, Zarrabian M, Kosashvili Y, Safir O, Gross AE, Backstein D. Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplasty 2010; 25: 1047-1052
45. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE. Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 2001; (392): 38-45
46. Chew JT, Stewart NJ, Hanssen AD, Luo ZP, Rand JA, An KN. Differences in patellar tracking and knee kinematics among three different total knee designs. Clin Orthop Relat Res 1997; (345): 87-98
47. Malo M, Vince KG. The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg 2003; 11: 364-371
48. D’Lima DD, Chen PC, Kester MA, Colwell CW. Impact of patellofemoral design on patellofemoral forces and polyethylene stresses. J Bone Joint Surg Am 2003; 85-A Suppl 4: 85-93
49. Varadarajan KM, Rubash HE, Li G. Are current total knee arthroplasty implants designed to restore normal trochlear groove anatomy? J Arthroplasty 2011; 26: 274-281
50. Anderl W, Pauzenberger L, Kölblinger R, Kiesselbach G, Brandl G, Laky B, Kriegleder B, Heuberer P, Schwameis E (2016) Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 24:102–111. 183
51. Renson L, Poilvache P, Wyngaert HVD (2014) Improved alignment and operating room efficiency with patient-specific instrumentation for TKA. Knee 21:1216–1220
52. Vaishya R, Vijay V, Birla VP, Agarwal AK (2016) Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty. World J Orthop 7:426–433.
53. Mannan A, Smith TO Favourable rotational alignment outcomes in PSI knee arthroplasty: A Level 1 systematic review and meta-analysis. Knee. 2016 Mar;23(2):186-90
54. Khuangsirikul S, Lertcharoenchoke T, Chotanaphuti T (2014) Rotational alignment of femoral component between custom cutting block and conventional technique in total knee arthroplasty. J Med Assoc Thai 97(Suppl 2):S47–S51
55. Silva A, Sampaio R, Pinto E (2014) Patient-specific instrumentation improves tibial component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 22:636–642
56. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11: S208-S228
57. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; 13-14
58. Cretu BS, Dragosloveanu C, Dragosloveanu S, Cristea S, Radiographic Evaluation of Alignment Following Total Knee Arthroplasty - a Systematic Review. Part II. Maedica (Buchar). 2018 Jun;13(2):105-111.
59. Chia SL, Merican AM, Devadasan B, et al. Radiographic features predictive of patellar maltracking during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009;10:1217–1224.
60. Heesterbeek PJ, Beumers MP, Jacobs WC, Havinga ME, Wymenga AB. A comparison of reproducibility of measurement techniques for patella position on axial radiographs after total knee arthroplasty. Knee. 2007;14:411–6
61. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop. 2016;474(8):1886–1893.
62. Yan CH, Chiu KY, Ng FY, Chan PK, Fang CX. Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2015;23:3637–3645.
63. Abane L, Anract P, Boisgard S, et al. A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomised controlled trial. Bone Joint J 2015;97-B:56–63.
64. Chen JY, Chin PL, Tay DK, et al. Functional Outcome and Quality of Life after Patient-Specific Instrumentation in Total Knee Arthroplasty. J Arthroplasty 2015;30:1724–1728.
65. Lachiewicz PF, Henderson RA. Patient-specific instruments for total knee arthroplasty. J Am Acad Orthop Surg 2013;21:513–518.
66. Pietsch M, Djahani O, Hochegger M, Plattner F, Hofmann S. Patient-specific total knee arthroplasty: the importance of planning by the surgeon. Knee Surg Sports Traumatol Arthrosc 2013;21:2220–2226
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