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Review
. 2020 Mar 10:2020:2164371.
doi: 10.1155/2020/2164371. eCollection 2020.

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Yipeng Lin  1 , Wufeng Cai  1 , Baoyun Xu  1 , Jian Li  1 , Yuan Yang  1 , Xuelin Pan  2 , Weili Fu  1
Affiliations
Review

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Yipeng Lin et al. Biomed Res Int. .

Abstract

Objective: To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI).

Methods: RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods.

Results: 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and.

Conclusion: PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
PRISMA flow diagram for selection of included RCTs.
Figure 2
Figure 2
Risk of bias of included studies. + = low risk; – = high risk; ? = unknown risk.
Figure 3
Figure 3
Forest plot operative time and blood loss. (a) Forest plot operative time, subgroup analysis by MRI-based and CT-based PSI. (b) Forest plot of blood loss evaluated by reduction of (A) hemoglobin and (B) volume of blood. PSI: patient-specific instrumentation; CI: conventional instrumentation; SD: standard difference.
Figure 4
Figure 4
Forest plot of malalignment of mechanical axis. Subgroup analysis by MRI-based and CT-based PSI. Abbreviations: PSI: patient-specific instrumentation; CI: conventional instrumentation; SD: standard difference.
Figure 5
Figure 5
Forest plot of malalignment of mechanical axis. Subgroup analysis by system-specific PSI. Abbreviations: PSI: patient-specific instrumentation; CI: conventional instrumentation; SD: standard difference. Other PSI systems: a: MyKnee; b: Materialise NV; c: Miscellaneous.
Figure 6
Figure 6
Forest plot of patient-reported outcomes, complications, and length of stay. (a) Forest plot of patient-reported outcomes: (A) Knee Society Score (KSS), subgroup analysis by KSS-knee and KSS-function. (B) Oxford Knee Society (OKS). (b) Forest plot of complications between PSI and CI. (c) Forest plot of length of stay in hospital (days) between PSI and CI. SD: standard difference; PSI: patient-specific instrumentation; CI: conventional instrumentation.
Figure 7
Figure 7
Funnel plots of publication bias. (a) Funnel plot for operative time. (b) Funnel plot for malalignment (hip-knee-ankle axis outliers). SE(log (SMD)): standard error (log (standardized mean difference)); SMD: standardized mean difference; SE(log (RR)): standard error (log (relative risk)); RR: relative risk.
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