Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty

Background: Patient specific cutting guides (PSC) in total knee arthroplasty (TKA) have recently been introduced, in which preoperative 3-dimensional imaging is used to manufacture disposable cutting blocks specific to a patient's anatomy. The purpose of this study was to compare the alignment accuracy of PSC to an imageless CAS system in TKA. Methods: Thirty-seven patients (41 knees), received a TKA using an imageless CAS system. Subsequently, 38 patients (41 knees), received a TKA using a MRI-based, PSC system. Postoperatively, standing AP hip-to-ankle radiographs were obtained, from which the lower extremity mechanical axis, tibial component varus/valgus, and femoral component varus/valgus mechanical alignment were digitally measured. Each measurement was performed by two blinded, independent observers, and interclass correlations were calculated. A student's two-tailed t test was used to compare the two cohorts (p-value<0.05 = significant). Results: In the PSC cohort, 70.7% of patients had an overall alignment within 3 degrees of a neutral mechanical axis (vs. 92.7% with CAS, p = 0.02), 87.8% had a tibial component alignment within 2 degrees of perpendicular to the tibial mechanical axis (vs. 100% with CAS, p = 0.04), and 90.2% had a femoral component alignment within 2 degrees of perpendicular to the femoral mechanical axis (vs. 100% with CAS, p = 0.2). Interclass correlation coefficients were good to excellent for all radiographic measurements. Conclusion: While PSC techniques appear sound in principle, this study did not demonstrate patient specific cutting guides to obtain the same degree of overall mechanical and tibial component alignment accuracy as a CAS technique. Level of evidence: III: Retrospective cohort study. (C) 2012 Elsevier B.V. All rights reserved.