Patient‐Specific Instrumentation in Total Knee Arthroplasty

This chapter presents a case scenario of a 65‐year‐old male patient with tricompartmental knee osteoarthritis. He is interested in total knee arthroplasty (TKA), and has heard about “personalized” implants on social media. Patient‐specific instrumentation (PSI) has increased in popularity in recent years as orthopedic surgery responds to growing trend of personalized medicine. Multiple randomized controlled trials have compared PSI to standard instrumentation in terms of radiographic outcomes. Computer‐assisted navigation and robotic‐assisted total joint replacement surgery do appear to result in accurate component positioning. Patient‐specific instrumentation has a theoretical potential to alleviate at least some of these concerns, such as component position, unnecessary bony resection, and soft tissue dissection. PSI is available in one of two main ways: through the company providing the TKA implants or through the hospital, in form of three‐dimensional planning and printing of instruments, followed by on‐site sterilization and packaging. The chapter provides recommendations for implementing evidence‐based practice in the clinical setting.