4 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A P R I L 2 0 1 6
we just open up the box and pin the guides to the femur and tibia to help guide
the cuts," says Lee E. Rubin, MD, FAAOS, assistant professor of orthopedic sur-
gery at Warren Alpert Medical School of Brown University in Providence, R.I.
By pre-planning the cuts, you can save time in the OR and get a more precise
alignment in the joint. Plus, some experts believe that you can lower the risk of
infection and blood loss, since you're not inserting metal rods inside the bones to
guide the incisions as you would with standard instrumentation.
However, Paul A. Manner, MD, FRCSC, joint replacement professor at the
University of Washington in Seattle, notes that studies backing up many of these
claims are still lacking. "There's no real evidence that customized cutting blocks
make a difference in terms of outcomes," he says.
Plus, Dr. Rubin says there are more upfront costs tacked onto the procedure
when using the patient-specific instrumentation, thanks to the addition of the
CT scan or MRI imaging, as well as the higher price tag for the guides them-
selves. While you can save time in the OR, surgeons may also have to put in
additional legwork before the procedure.
The cutting blocks can be used for nearly any patient undergoing a total knee
replacement, but many surgeons are trying to figure out which ones are best
served by the technology. "That's the question that everyone is trying to answer,"
says Dr. Rubin. "If you're going to spend the money on the process and the time
it takes to review the plans, it's best for patients with an unusual anatomy or
patients with severe deformities."
One step further
Dr. Buch says 3D-printed patient-specific implants designed to uniquely fit a
patient's anatomy are generating a lot of buzz. Like the cutting blocks, customized
implants require patients to undergo a pre-op CT scan. The implant manufacturer
then uses the scan and special computer software to design the unique implant and
customized cutting blocks. The implant is then created using 3D-printing technolo-
gy. It arrives at your facility in a single box along with all of the instrumentation your