Title : 3D-printed Patient-Specific Instrumentation (PSI) versus conventional techniques in Total Knee Arthroplasty (TKA): A systematic review and meta-analysis
Abstract:
Background: Three-Dimensional (3D) printed Patient-Specific Instrumentation (PSI) has emerged as an innovative approach in Total Knee Arthroplasty (TKA), aiming to enhance surgical accuracy and outcomes. However, its clinical advantages over Conventional Instrumentation (CI) remain a subject of ongoing debate.
Objective: To compare the clinical efficacy of 3D-printed PSI versus conventional instrumentation in primary TKA, focusing on surgical time, intraoperative blood loss, alignment accuracy, and malalignment rates.
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Fourteen comparative studies comprising a total of 2,704 TKA procedures were included. Comprehensive literature searches were performed across PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL. Primary outcomes were surgical time, intraoperative blood loss, Hip–Knee–Ankle (HKA) alignment accuracy, and the proportion of alignment outliers (defined as >±3° deviation). Meta-analyses were conducted using random-effects models, and heterogeneity was assessed using the I² statistic.
Results: Use of 3D-printed PSI significantly reduced the rate of HKA alignment outliers (OR=0.30; p<0.00001) and improved overall alignment accuracy (SMD=-0.27; p=0.02) compared to CI. PSI was also associated with significantly lower intraoperative blood loss (SMD= -1.05; p=0.009). No statistically significant difference in surgical time was observed (SMD=-0.78; p=0.17), though high heterogeneity was noted. Complication rates were comparable between groups.
Conclusion: 3D-printed PSI enhances alignment accuracy and reduces intraoperative blood loss in TKA without increasing perioperative risks. While functional outcomes are generally equivalent, PSI may offer particular value in complex cases or high-volume surgical settings. Further large-scale, high-quality randomized trials are warranted to assess long-term clinical and cost-effectiveness outcomes.
Keywords: 3D Printing, Patient-Specific Instrumentation, Total Knee Arthroplasty, Surgical Precision, Alignment Accuracy, Meta-Analysis.
