-
Supporting healthcare professionals
Supporting healthcare professionals for over 150
yearsNAVIO™Surgical System
Supporting healthcare professionals for over 150 years
Evidence in focusClinical summaries
Clinical evidence summaries on VISIONAIRE Cutting Guides
Supporting healthcare professionals
Supporting healthcare professionals for over 150
yearsVISIONAIRE™Cutting Guides
-
Purpose
To summarise the clinical studies aligned with the VISIONAIRE
Cutting Guides (Smith & Nephew Memphis, TN, USA)
meta-analysis.1
Clinical summaries
VISIONAIRE™ Cutting Guides
19 studies reporting on VISIONAIRE meta-analysis study outcomes
of interest1
59 studies reporting on VISIONAIRE1
Studies
Author/year Study titleStudy outcomes aligned with
meta-analysis*
Page number
Abane L, 2015 A comparison of patient-specific and conventional
instrumentation for total knee arthroplasty 4
Bali K, 2012 Custom-fit total knee arthroplasty: our initial
experience in 32 knees 4
Barke S, 2013 Patient-matched total knee arthroplasty: does it
offer any clinical advantages? 5
Daniilidis K and Tibesku CO, 2014
A comparison of conventional and patient-specific instruments in
total knee arthroplasty 5
DeHaan AM, 2014Patient-specific versus conventional
instrumentation for total knee arthroplasty: peri-operative and
cost differences
6
Heyse TJ and Tibesku CO, 2014
Improved femoral component rotation in TKA using
patient-specific instrumentation 7
Huijbregts HJ, 2016
Component alignment and clinical outcome following total knee
arthroplasty: a randomised controlled trial comparing an
intramedullary alignment system with patient-specific
instrumentation
7
Kosse NM, 2018Stability and alignment do not improve by using
patient-specific instrumentation in total knee arthroplasty: a
randomized controlled trial
8
Marimuthu K, 2014
A multi-planar CT-based comparative analysis of patient-specific
cutting guides with conventional instrumentation in total knee
arthroplasty
8
Moubarak H and Brilhault J, 2014
Contribution of patient-specific cutting guides to lower limb
alignment for total knee arthroplasty 9
Key: Study outcomes
Efficiency Accuracy
Patient outcomes
Evidence in focus
page 2 of 16
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Studies
Author/year Study titleStudy outcomes aligned with
meta-analysis*
Page number
Myers K, 2014An evaluation of the need for blood transfusion
when using patient specific instrumentation for total knee
arthroplasty
9
Nankivell M, 2015 Operative efficiency and accuracy of
patient-specific cutting guides in total knee replacement 10
Noble JW Jr, 2012 The value of patient-matched instrumentation
in total knee arthroplasty 10
Pfitzner T, 2014Small improvements in mechanical axis alignment
achieved with MRI versus CT-based patient-specific instruments in
TKA: a randomized clinical trial
11
Predescu V, 2017 Patient specific instrumentation versus
conventional knee arthroplasty: comparative study 11
Rathod PA, 2015 Reducing blood loss in bilateral total knee
arthroplasty with patient-specific instrumentation 12
Tammachote N, 2018
Comparison of customized cutting block and conventional cutting
instrument in total knee arthroplasty: a randomized controlled
trial
12
Vide J, 2017Patient-specific instrumentation in total knee
arthroplasty: simpler, faster and more accurate than standard
instrumentation – a randomized controlled trial
13
Vundelinckx BJ, 2013
Functional and radiographic short-term outcome evaluation of the
VISIONAIRE system, a patient-matched instrumentation system for
total knee arthroplasty
13
AbbreviationsTKA: total knee arthroplastyHKA: hip-knee-ankle
angle KSS: Knee Society Score
*Studies may include other study outcomes.
CAS: computer-assisted surgery Hb: haemoglobin
page 3 of 16
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Study design
• Prospective, randomised study evaluating coronal HKA
alignment, assessed radiographically 3 months post primary TKA
• Procedures were performed by six surgeons using VISIONAIRE™ (n
= 59) or conventional instrumentation (n = 67)
Key results
Accuracy
• Post-TKA HKA alignment at or within 3° of the planned
mechanical axis alignment was achieved in the majority of cases
with VISIONAIRE (67.8%) or conventional instrumentation (67.2%)
(Figure)
Conclusion
VISIONAIRE provided good implant position accuracy comparable to
conventional instrumentation.
Study design
• Prospective study evaluating coronal mechanical axis
alignment, assessed radiographically 6 weeks post TKA using
VISIONAIRE (n = 32)
• Ten patients had prior TKA on the other leg using conventional
technique (n=4) or computer-asssisted surgery (CAS; n=6)
Key results
Accuracy
• Post-TKA coronal mechanical axis alignment within 3° of
neutral was achieved in 90.6% (29/32) cases using VISIONAIRE, but
only 70.0% (7/10) of prior TKA cases with conventional or CAS
(Figure)
Conclusion
VISIONAIRE achieved a high level of implant position
accuracy.
A comparison of patient-specific and conventional
instrumentation for total knee arthroplasty2
Abane L, et al. Bone Joint J. 2015;97-B:56–63.
Custom-fit total knee arthroplasty: our initial experience in 32
knees3
Bali K, et al. J Arthroplasty. 2012;27:1149–1154.
Accuracy
Accuracy
Figure. Mechanical axis alignment
67.8%32.2%
of VISIONAIRE cases within 3° of the
planned mechanical axis alignment
0
20
40
60
80
100
Perc
enta
ge o
f cas
es w
ith m
echa
nica
l axi
s al
ignm
ent w
ithin
3°
of n
eutra
l (%
)
90.6%
70.0%
Figure. Mechanical axis alignment
VISIONAIRE Conventional/CAS
≤3° >3°
page 4 of 16
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Study design
• Retrospective review of radiographic HKA alignment 3.5 months
post-TKA
• Procedures were performed by a single surgeon using VISIONAIRE
(n = 150) or conventional instrumentation (n = 156)
Key results
Accuracy
• Post-TKA HKA alignment within 3° of 180° was achieved in
significantly more cases with VISIONAIRE than conventional
instrumentation (90.7% vs 78.8%; p = 0.003; Figure)
Efficiency
• Mean operative time was 51 minutes using VISIONAIRE or
conventional instrumentation
Conclusion
VISIONAIRE demonstrated significantly improved mechanical axis
alignment compared to conventional instrumentation.
0
50
60
70
80
90
100
90.7%
78.8%
Perc
enta
ge o
f cas
es w
ith m
echa
nica
l ax
is a
lignm
ent w
ithin
3°
or 18
0° (%
)
Figure. Frequency of post-TKA HKA alignment within 3° of
180°
p=0.003
Study design
• Retrospective review of TKA performed by a single surgeon
using VISIONAIRE™ (n=39) or conventional instrumentation (n = 50)
during the same period
• Postoperative component alignment, measured radiographically,
and perioperative outcomes were compared
Key results
Patient outcomes
• VISIONAIRE resulted in a mean length of stay of 5.74 days
compared to 6.72 days for conventional TKA (Figure)
Efficiency
• VISIONAIRE resulted in a mean operating time of 74.4 minutes
compared to 75.3 minutes for conventional TKA
Conclusion
VISIONAIRE demonstrated a mean reduction in hospital length of
stay of almost one day compared to conventional
instrumentation.
Patient-matched total knee arthroplasty: does it offer any
clinical advantages?4
Barke S, et al. Acta Orthop Belg. 2013;79:308–311.
A comparison of conventional and patient-specific instruments in
total knee arthroplasty5
Daniilidis K and Tibesku CO. Int Orthop. 2014;38:503–508.
Figure. Comparison of mean number of days spent in hospital
MTWTFSS
VISIONAIRE
5.74mean number of days
Conventional
6.72mean number of days
WEEK 1 4.6% time
reduction (0.98
fewer days)
VISIONAIRE
5.74mean number of days
Conventional
6.72mean number of days
VISIONAIRE Conventional
Efficiency
Patient outcomes
Efficiency Accuracy
page 5 of 16
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Study design
• Retrospective review of TKA performed by a single surgeon
using VISIONAIRE™ (n = 306) or conventional instrumentation (n =
50) during the same period
• Operating room time and turnover, and operative complication
frequency were compared
Key results
Efficiency
• VISIONAIRE resulted in a significantly shorter mean operating
room time (20.4 minutes less) compared to conventional TKA, (86.8
vs 107.2 minutes; p
-
Study design
• Retrospective analysis of femoral component rotation, assessed
using magnetic resonance imaging approximately 6 months
post-TKA
• A single surgeon performed the procedures using VISIONAIRE™ (n
= 46) or conventional instrumentation (n = 48)
Key results
Accuracy
• There were significantly fewer outliers >3° in the
VISIONAIRE group compared to conventional instrumentation (2.2 vs
22.9%; p = 0.003; Figure)
Conclusion
VISIONAIRE significantly improved femoral component rotation
compared to conventional instrumentation.
Improved femoral component rotation in TKA using
patient-specific instrumentation8
Heyse TJ and Tibesku CO. Knee. 2014;21:268–271.
Figure. Frequency of post-TKA femoral external rotation >3°
of optimal alignment
0
5
10
15
20
25 p=0.003
22.9%
2.2%
Study design
• Prospective, randomised study evaluating HKA alignment by
computed tomography scan approximately 6 weeks post-TKA
• Procedures were performed by two surgeons using VISIONAIRE (n
= 69) or conventional instrumentation (n = 64)
Key results
Patient outcomes
• At 3 months post-TKA, 12 complications were reported for
VISIONAIRE and 18 were reported for conventional
instrumentation
Efficiency
• Mean operative time was 49.8 minutes for VISIONAIRE and 52.3
minutes for conventional instrumentation (Figure)
Conclusion
VISIONAIRE has a mean operative time of approximately 50
minutes, with fewer complications reported at 3 months post
TKA.
Component alignment and clinical outcome following total knee
arthroplasty: a randomised controlled trial comparing an
intramedullary alignment system with patient-specific
instrumentation9
Huijbregts HJ, et al. Bone Joint J. 2016;98-B:1043–1049.
Figure. Mean operative time for VISIONAIRE TKA
49.8 mins mean
operative time
VISIONAIRE Conventional
Freq
uenc
y of
pos
t-TK
A fe
mor
al
exte
rnal
rota
tion
>3°
(%)
Accuracy
Efficiency
Patient outcomes
page 7 of 16
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Study design
• Prospective, randomised study evaluating stability and
alignment radiographically 12 months post-TKA
• Procedures were performed by three surgeons using VISIONAIRE™
(n = 21) or conventional instrumentation (n = 21)
Key results
Patient outcomes
• No reoperations were performed (Figure)
− Four adverse events were reported in both the VISIONAIRE group
and in the conventional group
Efficiency
• Mean operative time was 66 minutes for VISIONAIRE compared to
68 minutes for conventional TKA
Conclusion
VISIONAIRE achieved a reduced mean operative time compared to
conventional TKA, with no reoperations at 12 months post-TKA.
Study design
• Retrospective analysis of implant alignment and component
rotation post-TKA, assessed using computed tomography
• Two surgeons performed the procedures using VISIONAIRE (n =
115) or conventional instrumentation (n = 185)
Key results
Accuracy• Mean post-TKA HKA alignment within 3° of neutral was
achieved in
the vast majority of cases with VISIONAIRE (86.1%) or
conventional instruments (83.2%) (Figure)
Efficiency • Mean operative time was reported as 72.5 minutes
for VISIONAIRE and
75.0 minutes for conventional TKA
• Mean tourniquet time was reported as 13.5 minutes for
VISIONAIRE and 13.1 minutes for conventional TKA
Conclusion
VISIONAIRE provided accurate implant alignment, comparable to
conventional instrumentation.
Stability and alignment do not improve by using patient-specific
instrumentation in total knee arthroplasty: a randomized controlled
trial10
Kosse NM, et al. Knee Surg Sports Traumatol Arthrosc.
2018;26:1792–1799.
A multi-planar CT-based comparative analysis of patient-specific
cutting guides with conventional instrumentation in total knee
arthroplasty11
Marimuthu K, et al. J Arthroplasty. 2014;28:1138–1142.
Figure. Mechanical axis alignment
86.1% of VISIONAIRE caseswithin 3° of neutral
13.9%
Figure. Reoperations following VISIONAIRE TKA
0reoperations
Efficiency
Patient outcomes
Efficiency Accuracy
≤3° >3°
page 8 of 16
-
Study design
• Retrospective review of complications and operative outcomes
for TKA procedures performed by a single surgeon using VISIONAIRE
(n = 21) or conventional instrumentation (n = 24)
Key results
Patient outcomes• Mean length of hospital stay (bilateral TKA)
was significantly
shorter (18.4%) with VISIONAIRE versus conventional
instrumentation (3.1 vs 3.8 days; p = 0.01; Figure)
• Postoperative blood transfusion was not required in any
VISIONAIRE patients, but was required by five conventional TKA
patients
• One patient experienced a complication with VISIONAIRE,
compared to three patients with conventional TKA
Efficiency• Mean operative time per knee (unilateral TKA) was
significantly
shorter with VISIONAIRE versus conventional instrumentation
(89.6 vs 116.1 minutes; p < 0.01; Figure)
• Mean tourniquet time (unilateral TKA) was signficantly shorter
with VISIONAIRE versus conventional instrumentation (57.6 vs 91.8
minutes; p3°
page 9 of 16
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Study design• Prospective, randomised study evaluating
mechanical implant alignment post-TKA• Procedures were performed by
a single surgeon using VISIONAIRE (n = 15) or conventional
instrumentation (n = 14)
Key results
Patient outcomes• VISIONAIRE achieved significant reductions in
mean
length of hospital stay compared to conventional instrumentation
(59.2 vs 66.9 hours; p = 0.43; Figure 1)
Accuracy• Mean post-TKA mechanical alignment was
significantly
closer to neutral with VISIONAIRE versus conventional
instrumentation (1.7 vs 2.8°, p = 0.03; Figure 2)
Efficiency• VISIONAIRE resulted in significant reductions in
mean operative time compared to conventional instrumentation
(121.4 vs 128.1 minutes; p = 0.048; Figure 3)
• Mean number of instrument trays used per case was
significantly reduced with VISIONAIRE compared to conventional
instrumentation (4.3 vs 7.5; p < 0.0001; Figure 4)
ConclusionVISIONAIRE significantly improved mechanical alignment
and operative efficiency compared to conventional instrumentation,
along with significant reductions in length of hospital stay.
Study design
• Prospective evaluation of the accuracy of bone resection in
TKA performed by multiple surgeons using VISIONAIRE™ (n = 41)
Key results
Efficiency
• Compared to historic data from 45 TKAs with conventional
instruments
− Mean operative time was 84 minutes for VISIONAIRE and 88
minutes for conventional instrumentation (Figure)
− Mean tourniquet time was 82 minutes for VISIONAIRE and 85
minutes for conventional instrumentation (Figure)
Conclusion
VISIONAIRE demonstrated a slightly reduced mean surgical and
tourniquet time compared to conventional instrumentation.
Operative efficiency and accuracy of patient-specific cutting
guides in total knee replacement14 Nankivell M, et al. ANZ J Surg.
2015;85:452–455.
The value of patient-matched instrumentation in total knee
arthroplasty15 Noble JW Jr, et al. J Arthroplasty.
2012;27:153–155.
Figure. Comparison of VISIONAIRE to historic conventional TKA
data
VISIONAIRE Conventional
0
20
40
60
80
100
8488
82 85
Mea
n op
erat
ive
time
0
30
60
90
120
150
121.4 min 128.1 min
Mea
n nu
mbe
r of i
nstru
men
t tra
ys u
sed
per c
ase
0
1
2
3
4
5
6
7
8
4.3
7.5
Figure 3. Operative time Figure 4. Number of trays
VISIONAIRE Conventional
Efficiency
Efficiency Accuracy
Patient outcomes
5.2% reduction
42.7% reduction
Mea
n po
st-T
KA a
lignm
ent
0.0
0.5
1.0
1.5
2.0
2.5
3.0
1.7°
2.8°
Figure 2. Post-TKA alignment
p=0.03
p=0.048 p
-
Study design
• Prospective, randomised study evaluating alignment accuracy
radiographically post-TKA performed by a single surgeon
• Procedures used VISIONAIRE™ (n = 30), computed tomography
(CT)-based patient-specific instrumentation (PSI, n = 30) or
conventional instrumentation (n = 30)
Key results
Accuracy
• Mean post-TKA mechanical limb alignment at or within 3° of the
planned alignment was achieved more frequently with VISIONAIRE
(93%) versus CT-based PSI (70%) or conventional instrumentation
(57%) (Figure)
Conclusion
VISIONAIRE provided highly accurate mechanical alignment more
frequently than both CT-based PSI and conventional
instrumentation.
Small improvements in mechanical axis alignment achieved with
MRI versus CT-based patient-specific instruments in TKA: a
randomized clinical trial16
Pfitzner T, et al. J. Clin Orthop Relat Res.
2014;472:2913–2922.
Figure. Frequency of post-TKA coronal mechanical limb alignment
≤3° of planned
93% 70% 57%
VISIONAIRE CT-based PSI Conventional instrumentation
Study design
• Observational study evaluating HKA alignment radiographically
6 weeks post-TKA
• Procedures were performed by a single surgeon using VISIONAIRE
(n = 40) or conventional instrumentation (n = 40)
Key results
Patient outcomes
• Mean Hb loss (g/dl) was 3.5 for VISIONAIRE and 4.2 for
conventional TKA (Figure)
Accuracy
• Mean post-TKA HKA alignment at or within 3° of neutral was
achieved in all cases
Conclusion
VISIONAIRE achieved accurate alignment, with less Hgb loss than
conventional TKA.
Patient specific instrumentation versus conventional knee
arthroplasty: comparative study17 Predescu V, et al. Int Orthop.
2017;41:1361–1367.
Accuracy
Accuracy
Patient outcomes
Figure. Mean Hb loss
VISIONAIRE Conventional
Mea
n H
b lo
ss (g
/dl)
0
1
2
3
4
5
4.23.5
page 11 of 16
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Study design
• Retrospective study evaluating surgical time for bilateral
TKA
• Procedures were performed by a single surgeon using
VISIONAIRE™ ( 15 patients) or conventional instrumentation (14
patients)
Key results
Patient outcomes
• Few complications arose, with comparable frequency between
groups (Table)
Conclusion
Use of VISIONAIRE resulted in few post-TKA complications.
Reducing blood loss in bilateral total knee arthroplasty with
patient-specific instrumentation18 Rathod PA, et al. Orthop Clin
North Am. 2015;46:343–350.
Study design
• Prospective, randomised controlled trial evaluating HKA
alignment radiographically 3 months post-TKA
• Procedures were performed by a single surgeon using VISIONAIRE
(n = 51) or conventional instrumentation (n=51)
Key results
Patient outcomes• 37% (19) of patients required a blood
transfusion in the VISIONAIRE group compared
to 51% (26 patients) in the conventional TKA group
Accuracy• Mean post-TKA HKA coronal alignment within 3° of the
mechanical axis was
achieved in 94% of cases (48/51) using either VISIONAIRE or
conventional instruments
Efficiency• Mean operative time was 11 minutes (10.6%) shorter
with VISIONAIRE versus
conventional instruments (93 vs 104 minutes; Figure)
Conclusion
VISIONAIRE reduced operative time compared to conventional
instrumentation, while achieving fewer blood transfusions and
highly accurate limb alignment.
Comparison of customized cutting block and conventional cutting
instrument in total knee arthroplasty: a randomized controlled
trial19
Tammachote N, et al. J Arthroplasty. 2018;33:746–751.
Figure. Savings in operative time with VISIONAIRE, compared to
conventional TKA
11 minssaving in
operative time
Efficiency Accuracy
Patient outcomes
Table. Post-TKA complications
Group Deep vein thrombosis
Pulmonary embolism
Reoperation Manipulation under anaesthesia (stiffness)
VISIONAIRE 1 0 1 (haematoma) 2
Conventional instrumentation
1 0 0 2
Patient outcomes
page 12 of 16
-
Study design
• Prospective, randomised controlled trial evaluating coronal
alignment radiographically post-TKA
• A single surgeon used VISIONAIRE™ (n = 47) or conventional
instrumentation (n = 48)
Key results
Patient outcomes• VISIONAIRE significantly reduced mean length
of hospital stay by 0.7 days
(5.0 vs 5.7 days; p = 0.005) compared to conventional
instrumentation• Significantly fewer mean blood units were used
(0.02 vs 0.2; p = 0.024), and
patients were less likely to require blood transfusion (1.1 vs
7.7%; p = 0.024), with VISIONAIRE compared to conventional
instrumentation (Figure)
Accuracy• VISIONAIRE achieved mean post-TKA coronal alignment at
or within 3° of
neutral in significantly more cases than conventional
instrumentation (88.1 vs 64.1%; p = 0.011)
Efficiency• VISIONAIRE significantly reduced mean surgical time
by 18 minutes (24.8%;
54.4 vs 72.4 minutes; p=0.00) compared to conventional
instrumentation
Conclusion
VISIONAIRE achieved significantly more accurate coronal
alignment and reduced surgical time, length of hospital stay and
blood loss complications compared to conventional
instrumentation.
Study design
• Prospective study evaluating radiographic alignment and
functional outcomes for TKA
• Two surgeons were randomly assigned to perform procedures
using VISIONAIRE (n = 31) or conventional instrumentation (n =
31)
Key results
Patient outcomes
• No significant differences in length of hospital stay or blood
loss between VISIONAIRE and conventional TKA (6.68 vs 6.06 days,
respectively)
• VISIONAIRE required a mean of 4 units of blood for transfusion
compared to 6 units for conventional TKA (Figure)
Conclusion
VISIONAIRE may reduce the number of units of blood required for
transfusion compared to conventional TKA.
Patient-specific instrumentation in total knee arthroplasty:
simpler, faster and more accurate than standard instrumentation – a
randomized controlled trial20
Vide J, et al. Knee Surg Sports Traumatol Arthrosc.
2017;25:2616–2621.
Functional and radiographic short-term outcome evaluation of the
VISIONAIRE system, a patient-matched instrumentation system for
total knee arthroplasty21
Vundelinckx BJ, et al. J Arthroplasty. 2013;28:964–970.
Figure. Mean blood units required during TKA
0.02units of blood
0.2units of blood
VISIONAIRE Conventional instrumentation
Patient outcomes
90%relative
reduction
Efficiency Accuracy
Patient outcomes
Figure. Mean blood units required during TKA
VISIONAIRE Conventional instrumentation
4units of blood
6units of blood
page 13 of 16
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Notes
page 14 of 16
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Notes
page 15 of 16
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16596 V1 0419. Published April 2019, ©2019 Smith & Nephew.
Smith & Nephew, Inc, 1450 Brooks Road, Memphis, TN 38116, USA
™Trademark of Smith & Nephew. All rights reserved. All
trademarks acknowledged. www.smith-nephew.com
page 16 of 16
Disclaimer Great care has been taken to maintain the accuracy of
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References
1. Hicks C, Saunders C. VISIONAIRE: More efficient for total
knee arthroplasty (TKA) than conventional techniques. 2018.
Available at:
http://www.smith-nephew.com/education/resources/literature/scientific-literature/2018/visionaire-more-efficient-for-total-knee-arthroplasty-tka-than-conventional-techniques/.
Last accessed: 01 April 2019.
2. Abane L, Anract P, Boisgard S, et al. A comparison of
patient-specific and conventional instrumentation for total knee
arthroplasty: a multicentre randomised controlled trial. Bone Joint
J. 2015;97-B:56-63.3. Bali K, Walker P, Bruce W. Custom-fit total
knee arthroplasty: our initial experience in 32 knees. J
Arthroplasty. 2012;27:1149-1154.4. Barke S, Musanhu E, Busch C, et
al. Patient-matched total knee arthroplasty: does it offer any
clinical advantages? Acta Orthop Belg. 2013;79:307-311.5.
Daniilidis K, Tibesku CO. A comparison of conventional and
patient-specific instruments in total knee arthroplasty. Int
Orthop. 2014;38:503-508.6. DeHaan AM, Adams JR, DeHart ML, et al.
Patient-specific versus conventional instrumentation for total knee
arthroplasty: peri-operative and cost differences. J Arthroplasty.
2014;29:2065-2069.7. Drnek D, Haffner N, Sadjed A, et al.
Patient-specific instruments as a standard procedure in total knee
arthroplasty: Logistics and postoperative radiological results in
70 patients. CRCM. 2014;3:57-63.8. Heyse TJ, Tibesku CO. Improved
femoral component rotation in TKA using patient-specific
instrumentation. Knee. 2014;21:268-271.9. Huijbregts HJ, Khan RJ,
Fick DP, et al. Component alignment and clinical outcome following
total knee arthroplasty: a randomised controlled trial comparing an
intramedullary alignment system with patient-
specific instrumentation. Bone Joint J. 2016;98-B:1043-1049.10.
Kosse NM, Heesterbeek PJC, Schimmel JJP, et al. Stability and
alignment do not improve by using patient-specific instrumentation
in total knee arthroplasty: a randomized controlled trial. Knee
Surg Sports
Traumatol Arthrosc. 2018;26:1792-1799.11. Marimuthu K, Chen DB,
Harris IA, et al. A multi-planar CT-based comparative analysis of
patient-specific cutting guides with conventional instrumentation
in total knee arthroplasty. J Arthroplasty.
2014;29:1138-1142.12. Moubarak H, Brilhault J. Contribution of
patient-specific cutting guides to lower limb alignment for total
knee arthroplasty. Orthop Traumatol Surg Res. 2014;100:S239-242.13.
Myers K, Merwin SL, Cabrera B, et al. An evaluation of the need for
blood transfusion when using patient specific instrumentation for
total knee arthroplasty. Int J Orthopedics Rehabil.
2014;2:54-60.14. Nankivell M, West G, Pourgiezis N. Operative
efficiency and accuracy of patient-specific cutting guides in total
knee replacement. ANZ J Surg. 2015;85:452-455.15. Noble JW, Jr,
Moore CA, Liu N. The value of patient-matched instrumentation in
total knee arthroplasty. J Arthroplasty. 2012;27:153-155.16.
Pfitzner T, Abdel MP, von Roth P, et al. Small improvements in
mechanical axis alignment achieved with MRI versus CT-based
patient-specific instruments in TKA: a randomized clinical trial.
Clin Orthop
Relat Res. 2014;472:2913-2922.17. Predescu V, Prescura C, Olaru
R, et al. Patient specific instrumentation versus conventional knee
arthroplasty: comparative study. Int Orthop. 2017;41:1361-1367.18.
Rathod PA, Deshmukh AJ, Cushner FD. Reducing blood loss in
bilateral total knee arthroplasty with patient-specific
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