Does Patient-Specific Instrumentations Improve Short-Term Functional Outcomes After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis

Patient-specific instrumentation (PSI) has been recently introduced in knee arthroplasty. There is no strong evidence from meta-analysis on comparison of functional outcomes between PSI and conventional instrumentation.

Literature search of electronic databases PubMed, MEDLINE, and Cochrane Library for published randomized controlled trials was undertaken. Search was done using a predesigned search strategy. Eligible studies were critically appraised for the methodological quality using Cochrane Collaboration’s tool. Functional scores used for meta-analysis were Knee Society Knee Score, Knee Society Function Scores, Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index, and Visual Analogue Scale score for pain (0-10 scale).

Five randomized controlled trials involving 379 total knee arthroplasties were eligible to be included in the meta-analysis. No significant improvement in short-term functional outcomes was seen after using PSI compared to the control group in terms of Knee Society Knee Score (weighted mean difference 0.65, 95% CI −4.41 to 5.70, P = .80) and Knee Society Function scores (weighted mean difference 0.01, 95% CI −3.26 to 3.28, P = .99), Oxford Knee Score (weighted mean difference 3.36, 95% CI −3.48 to 10.00, P = .34), Western Ontario and McMaster Universities Arthritis Index (weighted mean difference −7.47, 95% CI −23.94 to 8.99, P = .37), and Visual Analogue Scale score for pain (weighted mean difference −0.10, 95% CI −0.41 to 0.21, P = .53).

Current literature is insufficient to address whether there is a benefit of PSI in total knee arthroplasty in terms of improvement in functional outcomes.