Patient-specific instrumentation makes sense in total knee arthroplasty

Abstract

Introduction: Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) surgery was initially developed to increase accuracy. The potential PSI benefits have expanded in the last decade, and other advantages have been published. However, different authors are critical of PSI and argue that the advantages are not such and do not compensate for the extra cost. This article aims to describe the recently published advantages and disadvantages of PSI. Areas covered: Narrative description of the latest publications related to PSI in accuracy, clinical and functional outcomes, operative time, efficiency, and other benefits. Expert opinion: We have published high accuracy of the system, with a not clinically relevant loss of accuracy, significantly higher precision with PSI than with conventional instruments, and a high percentage of cases in the optimal range and similar to that obtained with computer-assisted navigation, greater imprecision for tibial slope, a significant blood loss reduction, and time consumption, an acceptable and non-significant increase in the cost per procedure, and no difference in complications during hospital admission and at 90 days. We think that PSI will not follow the Scott Parabola and that it will continue to be a valuable type of device in some instances of TKA surgery.