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Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons?

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Title: Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons?
Authors: Jones, GG
Logishetty, K
Clarke, S
Collins, R
Jaere, M
Harris, S
Cobb, JP
Item Type: Journal Article
Abstract: INTRODUCTION: High-volume unicompartmental knee arthroplasty (UKA) surgeons have lower revision rates, in part due to improved intra-operative component alignment. This study set out to determine whether PSI might allow non-expert surgeons to achieve the same level of accuracy as expert surgeons. MATERIALS AND METHODS: Thirty-four surgical trainees with no prior experience of UKA, and four high-volume UKA surgeons were asked to perform the tibial saw cuts for a medial UKA in a sawbone model using both conventional and patient-specific instrumentation (PSI) with the aim of achieving a specified pre-operative plan. Half the participants in each group started with conventional instrumentation, and half with PSI. CT scans of the 76 cut sawbones were then segmented and reliably orientated in space, before saw cut position in the sagittal, coronal and axial planes was measured, and compared to the pre-operative plan. RESULTS: The compound error (absolute error in the coronal, sagittal and axial planes combined) for experts using conventional instruments was significantly less than that of the trainees (11.6°±4.0° v 7.7° ±2.3º, p = 0.029). PSI improved trainee accuracy to the same level as experts using conventional instruments (compound error 5.5° ±3.4º v 7.7° ±2.3º, p = 0.396) and patient-specific instruments (compound error 5.5° ±3.4º v 7.3° ±4.1º, p = 0.3). PSI did not improve the accuracy of high-volume surgeons (p = 0.3). CONCLUSIONS: In a sawbone model, PSI allowed inexperienced surgeons to achieve more accurate saw cuts, equivalent to expert surgeons, and thus has the potential to reduce revision rates. The next test will be to determine whether these results can be replicated in a clinical trial.
Issue Date: 1-Nov-2018
Date of Acceptance: 21-Aug-2018
URI: http://hdl.handle.net/10044/1/63796
DOI: https://dx.doi.org/10.1007/s00402-018-3031-9
ISSN: 0936-8051
Publisher: Springer Verlag
Start Page: 1601
End Page: 1608
Journal / Book Title: Archives of Orthopaedic and Trauma Surgery
Volume: 138
Issue: 11
Copyright Statement: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Science & Technology
Life Sciences & Biomedicine
Orthopedics
Surgery
Unicompartmental knee arthroplasty
Partial knee replacement
Patient-specific instrumentation
PSI
Patient-specific guides
3D printing
UNICOMPARTMENTAL KNEE ARTHROPLASTY
NATIONAL JOINT REGISTRY
COMPONENT POSITION
MATCHED PATIENTS
OXFORD UKA
REPLACEMENT
OUTCOMES
ENGLAND
WALES
1103 Clinical Sciences
Publication Status: Published
Conference Place: Germany
Open Access location: http://link.springer.com/article/10.1007/s00402-018-3031-9
Online Publication Date: 2018-09-03
Appears in Collections:Department of Surgery and Cancer