Meta-analysis Of Accuracy And Clinical Outcomes Following Total Knee Arthroplasty Assisted By Three-dimensional Patient Specific Instrumentation

Objective:To compare three-dimensional patient-specific instrumentation(PSI)with conventional instrumentation concerning the accuracy of re-established lower limb alignment,prosthetic component positioning and clinical outcomes after total knee arthroplasty(TKA).Methods:The randomized controlled trials that comparing three-dimensional patient-specific instrumentation(PSI)with conventional osteotomy instrumentation concerning the lower limb alignment and clinical efficacy following total knee arthroplasty(TKA)were searched through PubMed,Embase,CoChrane Library,CNKI,Chinainfo and other accessible electronic databases.Screening the articles precisely according to the inclusion criteria and exclusion criteria,then assessing the final included documents' quality and risk bias,Relevant data were extracted,consolidated and analyzed by Review Manager 5.3,the results will be reviewed in the end.Results:Eleven articles,including twelve trials were included in this Meta-analysis.There was no statistical difference in the post-operative hip-knee-ankle axis(lower limb mechanical axis)outliers[RR=0.88,95%CI(0.65,1.19),P=0.41>0.05];the coronal femoral component outliers[RR=0.76,95%CI(0.57,1.02),P=0.07 > 0.05];the coronal tibial component outliers[RR=1.19,95%CI(0.68,2.09),P=0.54 > 0.05];the sagittal femoral component outliers[RR=0.93,95%CI(0.67,1.30),P=0.67 > 0.05];post-operative complications[RR=1.66,95%CI(0.12,23.47),P=0.71>0.05];the OKS scores at 3months follow-up[MD=0.04,95%CI(-1.63,1.72),P=0.96 >0.05] after TKA between PSI and conventional instrumentation.However,the post-operative femoral component rotation outliers [RR=0.55,95%CI(0.33,0.94),P=0.03<0.05];the sagittal tibial component outliers[RR=1.67,95%CI(1.28,2.19),P=0.0002<0.05];operation time[MD=?4.54,95%CI(?5.33,?3.75),P<0.00001<0.05]indeed make statistical difference.Conclusion:Both PSI and traditional osteotomy have achieved the desired and comparable accuracy along with clinical efficacy.However,according to the current short-term follow-up results,it is concluded that PSI has no particular advantage compared with traditional osteotomy for primary knee arthroplasty without severe flexion contracture,valgus or varus deformity,and extraarticular deformity.Therefore,the theoretical advantages of PSI still need more follow-up textual research in order to obtain a higher level of evidence-based medicine,so as to guide clinical treatment more accurately.