PATIENT-SPECIFIC INSTRUMENTATION: ADDED COST AND UNPROVEN VALUE – AFFIRMS

A recent proposed modification in surgical technique in total knee arthroplasty (TKA) has been the introduction of patient specific instrumentation or custom cutting guides (CCGs). With CCGs, preoperative three-dimensional imaging is used to manufacture cutting blocks specific to a patient's native anatomy, with proposed benefits including their ease of use; a decrease in operative times and instrument trays and improved cost-efficiency; the ability to preoperative plan component size, alignment, and position; and an improvement in postoperative alignment versus the use of standard instrumentation. However, to date the majority of reports have not confirmed these proposed benefits.Prior studies focusing on cost-efficiency have shown limited benefits in terms of operating and room turnover times, which fail to offset the additional cost of preoperative imaging and fabrication of the CCGs. Furthermore, a number of reports have noted the frequent need for surgeon-directed changes and alterations in alignment...