Reducing blood loss in bilateral total knee arthroplasty with patient-specific instrumentation.

Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) has been introduced to obtain consistent alignment, prevent instrumentation of the medullary canal and improve operating room efficiency. This article compares simultaneous bilateral TKA performed with and without the use of PSI in terms of surgical time; blood loss and transfusion requirements; length-of-stay, early thromboembolic events and complication rates. There was a trend to reduced total blood loss (as measured by drop in hemoglobin values) and lower transfusion rate after surgery. Further research in the form of high quality randomized trials and cost-benefit analyses may help in further consolidation of these findings.

[1]  A David Paltiel,et al.  Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. , 2009, Archives of internal medicine.

[2]  B. J. Evanson,et al.  Nonunion of a pertrochanteric femur fracture due to a low-velocity gunshot. , 2011, American journal of orthopedics.

[3]  R. Barrack,et al.  Patient specific cutting blocks are currently of no proven value. , 2012, The Journal of bone and joint surgery. British volume.

[4]  Daniel J Berry,et al.  Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. , 2008, The Journal of bone and joint surgery. American volume.

[5]  R. Barrack,et al.  Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty? , 2012, Clinical orthopaedics and related research.

[6]  Robert L. Barrack,et al.  Are Patient-specific Cutting Blocks Cost-effective for Total Knee Arthroplasty? , 2012, Clinical orthopaedics and related research.

[7]  K. Daniilidis,et al.  A comparison of conventional and patient-specific instruments in total knee arthroplasty , 2014, International Orthopaedics.

[8]  B. Boonen,et al.  Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[9]  A. Lombardi,et al.  Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA , 2012, Clinical orthopaedics and related research.

[10]  W. Hamilton,et al.  Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. , 2013, The Journal of arthroplasty.

[11]  D. Brotman,et al.  Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty. , 2005, Mayo Clinic proceedings.

[12]  M. Stevens,et al.  The association between comorbidity and length of hospital stay and costs in total hip arthroplasty patients: a systematic review. , 2014, The Journal of arthroplasty.

[13]  Liesbeth Bruckers,et al.  Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. , 2013, The Journal of arthroplasty.

[14]  Licia K. Gaber-Baylis,et al.  Perioperative Outcomes after Unilateral and Bilateral Total Knee Arthroplasty , 2009, Anesthesiology.

[15]  Andy Khye Soon Yew,et al.  The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[16]  Ning Liu,et al.  The value of patient-matched instrumentation in total knee arthroplasty. , 2012, The Journal of arthroplasty.

[17]  C. Colwell,et al.  Thrombosis incidence in unilateral vs. simultaneous bilateral total knee arthroplasty with compression device prophylaxis. , 2013, The Journal of arthroplasty.

[18]  Michael A. Mont,et al.  Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment , 2009, International Orthopaedics.

[19]  S. Lee,et al.  Is TKA Using Patient-specific Instruments Comparable to Conventional TKA? A Randomized Controlled Study of One System , 2013, Clinical orthopaedics and related research.

[20]  C. Pornrattanamaneewong,et al.  A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. , 2013, The bone & joint journal.

[21]  Sébastien Lustig,et al.  Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty. , 2013, The Journal of arthroplasty.

[22]  Olivier Ethgen,et al.  Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. , 2004, The Journal of bone and joint surgery. American volume.

[23]  R. Henderson,et al.  Patient‐specific Instruments for Total Knee Arthroplasty , 2013, The Journal of the American Academy of Orthopaedic Surgeons.

[24]  Andrew D Pearle,et al.  Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty. , 2013, The Knee.