Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 23:13:1624600.
doi: 10.3389/fbioe.2025.1624600. eCollection 2025.

No difference between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty: an updated systematic review and meta-analysis

Long Shao #  1   2 , Xiang-Dong Wu #  3   4 , Yuhao Liu #  3 , Xing Wang  5 , Chunyan Li  6 , Kun Tao  1   2 , Shicheng Wang  1   2
Affiliations

No difference between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty: an updated systematic review and meta-analysis

Long Shao et al. Front Bioeng Biotechnol. .

Abstract

Object: Our previous systematic review of either computed tomography (CT)-based or magnetic resonance imaging (MRI)-based patient-specific instrumentation (PSI) systems in total knee arthroplasty (TKA) included literature up to June 2016. However, the quickly evolving field warranted an update. Therefore, the aim of this systematic review and meta-analysis was to provide updated, evidence-based insights comparing the outcomes of CT-based versus MRI-based PSI systems in TKA.

Methods: We conducted comprehensive searches of PubMed, Embase, and the Cochrane Library databases from inception to February 2025. Prospective comparative trials that compared CT-based versus MRI-based PSI systems for TKA were included. Our predefined primary outcome was the incidence of outliers in overall coronal limb alignment. Secondary outcomes encompassed the accuracy of component alignment, operation time, and clinical outcomes.

Results: Nine publications reporting seven eligible trials were identified. Six trials involving a total of 407 knees were included for qualitative analysis, with five trials suitable for quantitative meta-analysis. The integrated results revealed no significant differences between CT- and MRI-based PSI systems concerning the outlier incidence of coronal overall limb alignment, the outlier incidence of coronal/sagittal alignment of the femoral/tibial component, the angular errors of coronal overall limb alignment, the angular errors of the femoral/tibial component in the coronal plane, or incidence of change of implant size of the femoral/tibial component. However, CT-based PSI systems were associated with significantly greater angular errors in coronal limb alignment (mean difference [MD]: 0.69°; 95% CI, 0.03°-1.36°; P = 0.04) and a prolonged operative time (MD: 5.02 min; 95% CI, 1.26min-8.79 min; P = 0.009) when compared to MRI-based systems. Clinical outcomes, while not amenable to meta-analysis due to clinical heterogeneity, showed no significant differences between groups during short-to mid-term follow-up.

Conclusion: This finding is inconsistent with our previous study. Contrary to our previous findings, current evidence indicates no significant difference in alignment outcomes between CT-based and MRI-based PSI systems for TKA. Additionally, short-to mid-term clinical outcomes were comparable between the two imaging modalities.

Systematic review registration: identifier CRD42022339910.

Keywords: alignment; computed tomography; magnetic resonance imaging; patient-specific instrumentation; total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart illustrating the study selection process for the meta-analysis.
FIGURE 2
FIGURE 2
Risk of bias and Risk of bias summary across included studies.
FIGURE 3
FIGURE 3
Forest plots illustrating the pooled effects comparing CT-versus MRI-based Patient-Specific Instrumentation for: outliers incidence of the coronal overall limb alignment; - outliers incidence of the coronal alignment of the femoral component; - outliers incidence of the coronal alignment of the tibial component; - outliers incidence of the sagittal alignment of the femoral component; - outliers incidence of the sagittal alignment of the tibial component; CI, confidence interval; M-H, Mantel-Haenszel.
FIGURE 4
FIGURE 4
Forest plots demonstrating pooled effects comparing CT-versus MRI-based Patient-Specific Instrumentation for: - angular errors of coronal overall limb alignment; - angular errors of the femoral component in the coronal plane; - angular errors of the tibial component in the coronal plane; CI, confidence interval; M-H, Mantel-Haenszel.
FIGURE 5
FIGURE 5
Forest plot illustrating the pooled effect of CT-versus MRI-based PSI on operation time. CI, confidence interval; I-V, Inverse Variance.
FIGURE 6
FIGURE 6
Forest plots illustrating the pooled effects comparing CT-versus MRI-based Patient-Specific Instrumentation for: - change implant size of the femoral component; - change implant size of the tibial component. CI, confidence interval; M-H, Mantel-Haenszel.
FIGURE 7
FIGURE 7
Funnel plot assessing potential publication bias for the outliers incidence of the coronal overall limb alignment. RR, risk ratio.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. An V. V., Sivakumar B. S., Phan K., Levy Y. D., Bruce W. J. (2017). Accuracy of MRI-Based vs. CT-based patient-specific instrumentation in total knee arthroplasty: a meta-analysis. J. Orthop. Sci. 22 (1), 116–120. 10.1016/j.jos.2016.10.007 - DOI - PubMed
    1. Asada S., Mori S., Matsushita T., Nakagawa K., Tsukamoto I., Akagi M. (2014). Comparison of MRI- and CT-based patient-specific guides for total knee arthroplasty. Knee 21 (6), 1238–1243. 10.1016/j.knee.2014.08.015 - DOI - PubMed
    1. Barbash G. I., Glied S. A. (2010). New technology and health care costs--the case of robot-assisted surgery. N. Engl. J. Med. 363 (8), 701–704. 10.1056/nejmp1006602 - DOI - PubMed
    1. Bini S. A., Schilling P. L., Patel S. P., Kalore N. V., Ast M. P., Maratt J. D., et al. (2020). Digital orthopaedics: a glimpse into the future in the midst of a pandemic. J. Arthroplasty 35 (7S), S68–S73. 10.1016/j.arth.2020.04.048 - DOI - PMC - PubMed
    1. Deng T., Liu T., Lei Q., Cai L., Chen S. (2021). Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study. J. Orthop. Surg. Res. 16 (1), 309. 10.1186/s13018-021-02467-6 - DOI - PMC - PubMed

Publication types

LinkOut - more resources