PSI for Bilateral Simultaneous TKA in Sever Varus
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      the Purpose of this study was to evaluate the short term outcome of patient specific
      instrument (PSI) in cases of bilateral simultaneous total knee arthroplasty (TKA) for knee
      osteoarthritis with sever varus
    

Detailed description: 
      The incidence of knee Osteoarthritis is variable and it is very high in Far East 47.0% and
      70.2% in men and women respectively, while it is 17.2% and 82.8% in male and females
      respectively in Middle East. The incidence of bilateral knee Osteoarthritis is 48%. TKA is
      the standard treatment for Osteoarthritis. Many authors prefer bilateral simultaneous TKA can
      be performed for straight forward cases of Knee Osteoarthritis, although it has higher
      complication rate that could be discouraging.

      Knee Osteoarthritis could be associated with articular deformities such as varus, valgus,
      flexion deformity and rarely recurvatum. These deformities could be associated with bone
      loss, ligamentous laxity, leg length discrepancy, bilateral shortening and disfigurement.
      These deformities need to be corrected during TKA and this make the procedure more difficult
      especially in severe cases with associated problems as described above. Some patients with
      knee Osteoarthritis present late when the condition becomes bilateral with sever articular
      deformity. Late presentation is a common feather in developing countries and low income
      countries and also in Middle and Far East.

      With the progression of Knee Osteoarthritis patient's condition deteriorates gradually, both
      local and generally with increasing loss of cartilage and bone leading to deformities and
      joint laxity. This general condition with the increasing disability leads to high risk of
      associated obesity and comorbidities. The late presentation is multifactorial and complex to
      explain. There are obvious reasons such as economic constrain, late referral, lake of
      experienced surgeons and high demand and expectation such as full flexion in Middle and Far
      East. There are other unexplained reasons such as fear of surgeries, misconception about TKA
      and psychological factors.

      Unilateral TKA for patients with bilateral knee Osteoarthritis with sever articular
      deformities is not beneficial to the patients, as it does not allow correction of the
      deformities and easier rehabilitation, and may not be satisfying for the patient because
      patient left with a straight knee after TKA and a deformed knee in the other side that leads
      to difficult rehabilitation and may force the TKA to get the same deformity to adapt to the
      other knee. With this dissatisfaction the patient may refuse to have the other knee done.

      Bilateral simultaneous TKA in patient with sever articular deformities is beneficial to the
      patients as it allows correction of the deformities and easier rehabilitation.

      However bilateral simultaneous TKA for such complex cases is a very demanding procedure and
      could be associated with a higher rate of complications such as fat embolism , mortality,
      infection, bleeding, deep venous thrombosis, and general complications.

      PSI could be useful for bilateral simultaneous TKA because it eliminates the use of
      intramedullary guides and may reduce operative time, bleeding and risk of complications such
      as fat embolism or infection.

      The aim of this study is to review the outcome of using PSI in bilateral simultaneous TKA for
      patient with sever articular deformities which is common in middle east region.
    

Intervention name(s): Patient specific instrument; conventional technique for TKA
Intervention type(s): Other; Other
Intervention description(s): A special software with the ability to perform 3D planning including sizing, alignment, bone cutting, positioning of implants, simulation & PSI designing and PSI production
Other intervention name(s): PSI
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: PSI: Patient Specific Instrument; TKA: Total Knee Arthroplasty; Articular Deformity; Varus