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

Background: 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. Methods: 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). Results: 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). Conslusion: Current literature is insufficient to address whether there is a benefit of PSI in total knee arthroplasty in terms of improvement in functional outcomes. (C) 2016 Elsevier Inc. All rights reserved.