Published online Oct 18, 2020. doi: 10.5312/wjo.v11.i10.431
Peer-review started: April 18, 2020
First decision: August 9, 2020
Revised: August 18, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 18, 2020
New implants for total knee arthroplasty (TKA) are continuously introduced with the proposed benefit of increased performance and improved outcome. Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.
To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.
A novel TKA system was introduced at our institution on 30th November 2015. Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons (25 TKAs/surgeon) were identified as the Introduction Group. Moreover, the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group. A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period. Demographics, surgery-related factors and alignment data were recorded, and intergroup differences compared.
Following introduction of the novel implant, Persona TKA was utilized in 69% (71%), 53% (54%), and 45% (75%) of primary TKA procedures by the three surgeons, respectively (Follow-up Group). Mean surgery time was increased by 28% (P < 0.0001) and mean intra-operative blood loss by 25% (P = 0.002) in the Introduction Group, while only the mean surgery time was increased in the Follow-up Group by 18% (P < 0.0001). Overall alignment was similar between the groups apart from femoral flexion (FF) and tibial slope (TS). The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.
Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction. These differences diminished one year after introduction of the new implant. Fewer outliers with respect to FF and TS were seen when using the novel TKA implant. Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.
Core Tip: Limited information exists in the literature on how the introduction of a novel total joint arthroplasty (TKA) system translates to improvements in early surgical outcome and component alignment in first adopters. The introduction of a novel TKA implant increased surgical time and intraoperative blood loss immediately after its introduction, but diminished one year after introduction of the implant. As only minor improvements with respect to optimal TKA alignment were observed following its introduction, surgeons should take increased care when introducing new procedures and consider logistics when selecting novel implants, as small gains in alignment should be balanced against inferior peri-operative outcomes.