Does Patient-Specific Instrumentation Improve Femoral and Tibial Component Alignment in Total Knee Arthroplasty? A Prospective Randomized Study

  • Artur Stolarczyk
  • Lukasz Nagraba
  • Tomasz Mitek
  • Magda Stolarczyk
  • Jarosław Michał Deszczyński
  • Maciej Jakucinski
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1096)


Alignment of the prosthesis is one of the most significant factors that affect the long-term clinical outcome following total knee arthroplasty (TKA). There is conflicting evidence whether patient-specific instrumentation (PSI) for TKA improves the component position compared to standard instrumentation. This study aimed to compare the rotational alignment of the femoral and tibial components in TKA patients when performed with either conventional or PSI. Sixty patients with primary knee osteoarthritis were randomly divided into two groups treated surgically with TKA: one with conventional instrumentation and the other with the Visionaire PSI system (Smith and Nephew, Memphis, TN). Computerized tomography (CT) and X-ray imaging were performed preoperatively and 12 weeks after surgery. The rotational alignment of the femoral and tibial component in all patients was assessed postsurgically using CT imaging according to the Berger protocol. Both groups were clinically assessed in a blinded fashion using the Knee Society Score (KSS) and a visual analog scale (VAS). Fifty-eight patients were prospectively assessed. The mean postsurgical follow-up was 3.0 ± 0.4 months. CT images did not reveal any significant improvement in the rotational alignment of the implant components between the groups. X-rays revealed a significant improvement in the deviation from the optimal alignment range of the femoral component in the coronal plane in both groups. Patients operated with Visionaire PSI assistance had poorer functional outcomes. We conclude that there were no improvements in clinical outcomes or knee component alignment in patients treated with PSI compared with those treated with standard instruments. In addition, clinical and functional assessment showed inferior results in terms of KSS and VAS scores at the midterm follow-up in patients treated with PSI.


Computerized tomography Femoral component rotation Knee arthroplasty Patient-specific instrumentation Rotational alignment Tibia 


Conflicts of Interest

The authors declared no conflicts of interest in relation to this article.


  1. Bedard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469(8):2346–2355CrossRefPubMedPubMedCentralGoogle Scholar
  2. Berger RA, Crossett LS (1998) Determining the rotation of the femoral and tibial components in total knee arthroplasty: a computed tomography technique. Oper Tech Orthop 8:128–133CrossRefGoogle Scholar
  3. Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36(8):1589–1593CrossRefPubMedPubMedCentralGoogle Scholar
  4. Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2013) Evaluation of the accuracy of a patient-specific instrumentation by navigation. Knee Surg Sports Traumatol Arthrosc 21(10):2194–2199CrossRefPubMedGoogle Scholar
  5. Fu H, Wang J, Zhou S, Cheng T, Zhang W, Wang Q, Zhang X (2015) No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 23(11):3288–3295CrossRefPubMedGoogle Scholar
  6. Heyse TJ, Tibesku CO (2014) Improved femoral component rotation in TKA using patient-specific instrumentation. Knee 21(1):268–271CrossRefPubMedGoogle Scholar
  7. Heyse TJ, Tibesku CO (2015) Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg 135(5):697–701CrossRefPubMedGoogle Scholar
  8. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surgery Br 73(5):709–714CrossRefGoogle Scholar
  9. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplast 20(7):832–839CrossRefGoogle Scholar
  10. Laskin RS (2003) Instrumentation pitfalls: you just can’t go on autopilot! J Arthroplast 18(3 Suppl 1):18–22CrossRefGoogle Scholar
  11. Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59(1):77–79CrossRefPubMedGoogle Scholar
  12. Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 press fit condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplast 16(5):635–640CrossRefGoogle Scholar
  13. Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470(1):99–107CrossRefPubMedGoogle Scholar
  14. Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92(9):1238–1244CrossRefPubMedGoogle Scholar
  15. Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470(3):895–902CrossRefPubMedGoogle Scholar
  16. Petersen TL, Engh GA (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplast 3(1):67–72CrossRefGoogle Scholar
  17. Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res (232):168–173Google Scholar
  18. Reed SC, Gollish J (1997) The accuracy of femoral intramedullary guides in total knee arthroplasty. J Arthroplast 12(6):677–682CrossRefGoogle Scholar
  19. Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res (299):153–156Google Scholar
  20. Stronach BM, Pelt CE, Erickson JA, Peters CL (2014) Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment. J Arthroplast 29(9):1705–1708CrossRefGoogle Scholar
  21. Woolson ST, Harris AH, Wagner DW, Giori NJ (2014) Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 96(5):366–372CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Artur Stolarczyk
    • 1
  • Lukasz Nagraba
    • 2
  • Tomasz Mitek
    • 2
  • Magda Stolarczyk
    • 2
  • Jarosław Michał Deszczyński
    • 1
  • Maciej Jakucinski
    • 3
  1. 1.Department of Clinical RehabilitationWarsaw Medical UniversityWarsawPoland
  2. 2.Department of Orthopedics and RehabilitationWarsaw Medical UniversityWarsawPoland
  3. 3.Department of RadiologyWarsaw Medical UniversityWarsawPoland

Personalised recommendations