Alignment and Component Position after Patient-Matched Instrumentation versus Conventional Total Knee Arthroplasty

Purpose To compare patient-matched instrumentation (PMI) with conventional total knee arthroplasty (TKA) in terms of limb alignment and component position. Methods Nine men and 36 women (mean age, 69.5 years) who underwent PMI TKA were compared with 20 men and 25 women (mean age, 69.3 years) who underwent conventional TKA by the same team of surgeons with the same prosthesis and protocols in terms of limb alignment and component position using the Perth protocol computed tomography, as well as bone resection measurements, operating time, and the number of trays used. Results The PMI and conventional TKA groups were comparable in terms of age, body mass index, tourniquet time, operating time, and the number of trays used. For limb alignment and component position, the 2 groups differed significantly in sagittal femoral component position (2.4° vs. 0.9°, p=0.0008) and the percentage of knees with femoral component internally rotated ≥1° with respect to the transepicondylar axis (20% vs. 55%, p=0.001). The difference was not significant in terms of limb alignment, coronal and rotational femoral component position, or coronal and sagittal tibial component position. Intra-operatively, all patient-matched cutting blocks demonstrated acceptable fit and stability. No instrument-related adverse events or complications were encountered. One (2.2%) femur and 6 (13.3%) tibiae were recut 2 mm for optimal ligament balancing. Two femoral components were upsized to the next size, and 2 tibial components were upsized and 2 downsized to the next size. Conclusion PMI was as accurate as conventional instrumentation in TKA. There was no significant difference in limb alignment or femoral and tibial component position in the coronal and sagittal planes between PMI and conventional TKA. PMI had a higher tendency to achieve correct femoral component rotation.