Abstract
Patient-specific instrumentation (PSI) has been greatly marketed in knee endoprosthetics for the past few years. By utilising PSI, the prosthesis´ accuracy of fit should be improved. Besides, both surgical time and hospital costs should be reduced. Whether these proposed advantages are achieved in medial UKA remains unclear yet. The aim of this study was to evaluate the preoperative planning accuracy, time saving, and cost effectiveness utilising PSI in UKA.
Data from 22 patients (24 knees) with isolated medial unicompartmental knee osteoarthritis were analysed retrospectively. The sample comprised sixteen men and six women (mean age 61 ± 8 years) who were electively provided with a UKA utilising PSI between June 2012 and October 2014. For evaluation of preoperative planning accuracy (1) planned vs. implanted femoral component size, (2) planned vs. implanted tibial component size, and (3) planned vs. implanted polyethylene insert size were analysed. Since UKA is a less common, technically demanding surgery, depending in large part on the surgeon´s experience, preoperative planning reliability was also evaluated with regard to surgeon experience. Moreover, actual surgical time and cost effectiveness utilising PSI was evaluated.
Preoperative planning had to be modified intraoperatively to a wide extend for gaining an optimal outcome. The femoral component had to be adjusted in 41.7% of all cases, the tibial component in 58.3%, and the insert in 87.5%. Less experienced surgeons had to change preoperative planning more often than experienced surgeons. Utilising PSI increased surgical time regardless of experience. Linear regression revealed PSI-planning and surgeon inexperience as main predictors for increased surgical time. Additionally, PSI increased surgical costs due to e.g. enlarged surgical time, license fees and extraordinary expenditure for MRI scans.
The preoperative planning accuracy depends on many different factors. The advertised advantages of PSI could not be fully supported in case of UKA on the basis of the here presented data – especially not for the inexperienced surgeon.
