title: The impact of custom cutting guides on patient satisfaction and residual symptoms following total knee arthroplasty.
abstract: BACKGROUND
  Custom cutting guides (CCGs) in total knee arthroplasty (TKA) use preoperative three-dimensional (3-D) imaging to manufacture cutting blocks specific to a patient's anatomy. The purpose of this study was to evaluate the impact of CCGs versus standard intramedullary and extramedullary guides on patient-reported satisfaction and residual symptoms following TKA.
  
  
  METHODS
  A retrospective, multicenter study was performed to compare a magnetic resonance imaging-based CCG system versus standard instrumentation. All patients received the same, cemented, fixed-bearing, cruciate-retaining component, and had a primary diagnosis of osteoarthritis. Data was collected by an independent, third party survey center blinded to surgical technique that administered telephone questionnaires assessing patient satisfaction and symptoms. Patient age, gender, minority status, education level, income, length of follow-up, and pre-arthritic UCLA scores were considered potential confounders and accounted for using multivariate logistic regression analyses.
  
  
  RESULTS
  448 patients (107 CCGs, 341 standard) were successfully interviewed. At a mean follow-up of threeyears, there was no difference in percentage of patients reporting their knee to feel "normal" (74% CCG versus 78% standard, p=0.37). Residual symptoms including knee stiffness (37% CCG versus 28% standard, p=0.08) and difficulty getting in and out of car (34% CCG versus 30% standard, p=0.40) remained high. Multivariate regression analyses demonstrated no differences between the two cohorts for both patient-reported satisfaction and residual symptoms (odds ratios 0.72 to 1.48; p=0.10 to 0.81).
  
  
  CONCLUSIONS
  When interviewed by an independent, blinded third party, the use of CCGs in TKA did not improve patient-reported satisfaction or residual symptoms versus the use of standard alignment guides.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA. Electronic address: namd@wudosis.wustl.edu.
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
authors.affiliation: Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.affiliation: Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007720:Knee Prosthesis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery; D017060:Patient Satisfaction; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Alignment; Custom cutting guides; Patient satisfaction; Standard instrumentation; Total knee arthroplasty