At the 23rd annual meeting of the American Association of Hip and Knee Surgeons in Dallas, Texas, November 8 through 10, 2013, a paper was presented by Dr. Hamula, Et Al, evaluating the use of patient-specific cutting guides for total knee replacement. Their study demonstrated use of these guides was not superior to standard instrumentation with regard to alignment of the knee replacement. There was an increased cost associated with these guides associated with the preop MRI or CT scan that was required as well as the additional expense of the cutting guide.
This study comes to a similar conclusion as one that I recently had accepted in “The Journal of Arthroplasty” in 2013. We found that use of patient-specific cutting guides yielded similar results to conventional instrumentation as well as computer-assisted instrumentation. There is some additional cost, which is partially offset by the increased efficiency of the procedure.
We currently use these guides in patients who have specific deformities that preclude the use of conventional instrumentation. In that setting, they are extremely useful for improving accuracy of the knee replacement. While widespread use for routine cases may not be justified, use of these guides is extremely helpful in specific situations.