title: Patient-specific instruments in total knee arthroplasty.
abstract: OBJECTIVE
  In recent years, patient-specific instruments (PSI) has been introduced with the aim of reducing the overall costs of the implants, minimising the size and number of instruments required, and also reducing surgery time. The purpose of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability of patient specific instrument system in total knee arthroplasty (TKA).
  
  
  METHODS
  A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications.
  
  
  RESULTS
  Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%.
  
  
  CONCLUSIONS
  PSI seem not to be able to result in the same degree of accuracy as the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers.
authors.affiliation: Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "Sapienza", Via Grottarossa 1035, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Conteduca
authors.forename: Raffaele
authors.initials: R
authors.lastname: Iorio
authors.forename: Daniele
authors.initials: D
authors.lastname: Mazza
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferretti
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods; D017760:Bone Malalignment / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D007720:Knee Prosthesis / Q000592:standards*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017060:Patient Satisfaction; D010361:Patients; D017755:Prosthesis Fitting / Q000592:standards*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome