Improved Knee Function with Customized Vs. Off-the-Shelf TKA Implants-Results of a Single-Surgeon, Single-Center, Single-Blinded Study

Overview

Journal J Pers Med

Date 2023 Aug 25

PMID 37623507

Authors

Peter Buschner

Ioannis Toskas

Jochen Huth

Johannes Beckmann

Affiliations

Soon will be listed here.

Abstract

Background: Recent studies have been able to show certain benefits of Customized, Individually Made (CIM) compared to Off-the-Shelf (OTS) total knee arthroplasties (TKAs), but evidence is still lacking regarding the benefits of these implant systems. This study aimed to find differences in scores and functional outcome by comparing CIM and OTS implants, using Patient-Reported Outcome Measures (PROMs) and functional tests for activities of daily living in a single-surgeon setup.

Methods: A total of 48 patients (16 CIM vs. 32 OTS) were consecutively enrolled and blindly examined. Functional testing was performed using four timed functional tests (TUG, WALK, TUDS, and BBS) and the VAS for pain. The Aggregated Locomotor Function (ALF) score was then calculated based on the addition of the average times of the three functional tests.

Results: The CIM group showed significantly faster times in all functional tests and significantly better ALF scores. There were remarkable differences in the assessment of maximum pain sensation between the two groups, with superiority in the CIM group. The PROMs analysis revealed a higher proportion of excellent and good ratings for the items objective and function (KSS) in the CIM group.

Conclusion: The study showed that time-limited activities of daily living (ADLs) can be completed significantly faster with a CIM prosthesis and that a significantly higher percentage in this group reports freedom from pain during certain loads. Partial aspects of the PROM scores are also better in this group; however, this superiority could not be shown with regard to most PROM scores collected in this study.

Citing Articles

High patient satisfaction with Customized Total Knee Arthroplasty at five year follow-up.

Schippers P, Wunderlich F, Afghanyar Y, Buschmann V, Klonschinski T, Drees P Int Orthop. 2024; 48(12):3101-3108.

PMID: 39320497 PMC: 11564282. DOI: 10.1007/s00264-024-06325-y.

References

Reimann P, Brucker M, Arbab D, Luring C . Patient satisfaction - A comparison between patient-specific implants and conventional total knee arthroplasty. J Orthop. 2019; 16(3):273-277. PMC: 6475628. DOI: 10.1016/j.jor.2019.03.020. View

Murray D, Liddle A, Liddle A, Dodd C, Pandit H . Unicompartmental knee arthroplasty: is the glass half full or half empty?. Bone Joint J. 2015; 97-B(10 Suppl A):3-8. PMC: 4632649. DOI: 10.1302/0301-620X.97B10.36542. View

Schroeder L, Dunaway A, Dunaway D . A Comparison of Clinical Outcomes and Implant Preference of Patients with Bilateral TKA: One Knee with a Patient-Specific and One Knee with an Off-the-Shelf Implant. JBJS Rev. 2022; 10(2). DOI: 10.2106/JBJS.RVW.20.00182. View

Ratano S, Muller J, Daxhelet J, Beckers L, Bondoux L, Tibesku C . Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits. Knee Surg Sports Traumatol Arthrosc. 2022; 30(9):2958-2965. DOI: 10.1007/s00167-022-06867-x. View

Steinert A, Sefrin L, Hoberg M, Arnholdt J, Rudert M . [Individualized total knee arthroplasty]. Orthopade. 2015; 44(4):290-2, 294-301. DOI: 10.1007/s00132-015-3104-1. View

Eckhard L, Munir S, Wood D, Talbot S, Brighton R, Walter B . The KOOS-12 shortform shows no ceiling effect, good responsiveness and construct validity compared to standard outcome measures after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2020; 29(2):608-615. DOI: 10.1007/s00167-020-05904-x. View

Torok L, Javor P, Hartmann P, Banki L, Varga E . Should we abandon the patient-specific instrumentation ship in total knee arthroplasty? Not quite yet!. BMC Musculoskelet Disord. 2021; 22(1):730. PMC: 8386088. DOI: 10.1186/s12891-021-04581-2. View

Schwechter E, Fitz W . Design rationale for customized TKA: a new idea or revisiting the past?. Curr Rev Musculoskelet Med. 2012; 5(4):303-8. PMC: 3702755. DOI: 10.1007/s12178-012-9143-x. View

Meier M, Webb J, Collins J, Beckmann J, Fitz W . Do modern total knee replacements improve tibial coverage?. Knee Surg Sports Traumatol Arthrosc. 2018; 26(11):3219-3229. DOI: 10.1007/s00167-018-4836-3. View

10.

Beit Ner E, Dosani S, Biant L, Tawy G . Custom Implants in TKA Provide No Substantial Benefit in Terms of Outcome Scores, Reoperation Risk, or Mean Alignment: A Systematic Review. Clin Orthop Relat Res. 2021; 479(6):1237-1249. PMC: 8133244. DOI: 10.1097/CORR.0000000000001651. View

11.

Insall J, Binazzi R, Soudry M, Mestriner L . Total knee arthroplasty. Clin Orthop Relat Res. 1985; (192):13-22. View

12.

Wilson H, Middleton R, Abram S, Smith S, Alvand A, Jackson W . Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ. 2019; 364:l352. PMC: 6383371. DOI: 10.1136/bmj.l352. View

13.

Bonnin M, Beckers L, Leon A, Chauveau J, Muller J, Tibesku C . Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2020; 30(2):464-475. PMC: 8866384. DOI: 10.1007/s00167-020-06153-8. View

14.

Nam D, Nunley R, Barrack R . Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J. 2014; 96-B(11 Supple A):96-100. DOI: 10.1302/0301-620X.96B11.34152. View

15.

Angerame M, Holst D, Jennings J, Komistek R, Dennis D . Total Knee Arthroplasty Kinematics. J Arthroplasty. 2019; 34(10):2502-2510. DOI: 10.1016/j.arth.2019.05.037. View

16.

Steinert A, Sefrin L, Jansen B, Schroder L, Holzapfel B, Arnholdt J . Patient-specific cruciate-retaining total knee replacement with individualized implants and instruments (iTotal™ CR G2). Oper Orthop Traumatol. 2020; 33(2):170-180. DOI: 10.1007/s00064-020-00690-8. View

17.

Thienpont E, Bernardoni M, Goldberg T . Anthropometric measurements of the femur change with component positioning in total knee arthroplasty. Knee. 2016; 23(5):796-800. DOI: 10.1016/j.knee.2015.11.010. View

18.

Parvizi J, Nunley R, Berend K, Lombardi Jr A, Ruh E, Clohisy J . High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res. 2013; 472(1):133-7. PMC: 3889453. DOI: 10.1007/s11999-013-3229-7. View

19.

Meier M, Zingde S, Steinert A, Kurtz W, Koeck F, Beckmann J . What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees. Clin Orthop Relat Res. 2019; 477(3):561-570. PMC: 6382181. DOI: 10.1097/CORR.0000000000000611. View

20.

Wang H, Foster J, Franksen N, Estes J, Rolston L . Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement. Int Orthop. 2017; 42(4):805-810. DOI: 10.1007/s00264-017-3622-z. View