Patients preferred customized implant to off-the-shelf implant after bilateral TKA
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Published results showed patients who underwent staged bilateral total knee arthroplasty with both a customized implant and off-the-shelf implant preferred the customized implant and reported better functional outcomes.
Lennart Schroeder, MD, and colleagues collected the Knee injury and Osteoarthritis Outcome Score for Joint Replacement and the Forgotten Joint Score among 47 patients who underwent staged bilateral TKA with a customized implant in one knee and an off-the-shelf implant in the contralateral knee. Researchers also collected patients’ perceived joint stability, knee mobility, perceived feeling of the replaced joint, pain levels and overall preference between their knees with a follow-up questionnaire.
Results showed the customized implant had significantly higher KOOS JR and Forgotten Joint Scores. Researchers found 49% of patients reported having “a little” or “a lot” less pain with the customized implant vs. 15% with the off-the-shelf implant. The customized implant also had better perceived mobility and stability among 45% and 36% of patients, respectively, compared with 12% and 13% of off-the-shelf implants, according to results. Researchers also noted 60% of patients reported a more “normal” feeling of their knee with the customized implant vs. 10% with the off-the-shelf implant. In a direct comparison of the knees, results showed 72.3% of patients preferred the customized implant, 21.3% reported no difference in implant preference and 6.4% preferred the off-the-shelf implant.
“Going forward, I am hopeful that these results may encourage further research into which patients may benefit most from a fully personalized TKA,” Schroeder, orthopedic surgery resident at the Musculoskeletal University Center Munich, Ludwig Maximilian University in Munich, Germany, told Healio. “It is no secret that many surgeons are, by nature, conservative and naturally adhere to the technologies they trained on and have used for years. The JBJS Reviews study provides clinical evidence that personalized implant technology may further enhance patient care in the search for the ‘happiest’ patient.”
Perspective
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There are concerns with the methodology of this study: The patients were not blinded and so there is a substantial risk of bias in favor of the custom knee, the "off-the-shelf" implants are not specified and could represent a variety of devices, and 36% of the off-the-shelf implants were implanted by unknown surgeons with unspecified techniques. Modern primary knee systems have a wide variety of sizing options that allow the skilled surgeon to "customize" the fit to the individual patient.
Adding cost for custom implants is, in my opinion, money not well spent. Instead, I believe attention to "customizing" the surgical procedure by employing options including robotics, patient-specific instruments and/or kinematic alignment will pay higher dividends in terms of improving patient outcomes.
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