Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2015; 6(2): 290-297
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.290
Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty
Paul Stirling, Rejith Valsalan Mannambeth, Agustin Soler, Vineet Batta, Rajeev Kumar Malhotra, Yegappan Kalairajah
Paul Stirling, Rejith Valsalan Mannambeth, Agustin Soler, Yegappan Kalairajah, Department of Orthopaedic Surgery, Luton and Dunstable University Hospital, Luton LU4 0DZ, United Kingdom
Vineet Batta, Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, United Kingdom
Rajeev Kumar Malhotra, University College of Medical Sciences, Delhi 110095, India
Author contributions: All authors contributed equally to the research and writing of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Paul Stirling, COMET, Department of Orthopaedic Surgery, Luton and Dunstable University Hospital, Lewsey Road, Bedfordshire, England, Luton LU4 0DZ, United Kingdom.
Telephone: +44-1582-491166
Received: February 27, 2014
Peer-review started: February 27, 2014
First decision: April 28, 2014
Revised: August 15, 2014
Accepted: September 4, 2014
Article in press: September 10, 2014
Published online: March 18, 2015

AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation (PSI) surgery.

METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography (CT) or magnetic resonance imaging (MRI).

RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant.

CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.

Keywords: Patient-specific instrumentation, Arthroplasty, Alignment, Accuracy, Cost-effectiveness

Core tip: At present there is not enough published data to convincingly conclude in favour of computerised tomography (CT) or magnetic resonance imaging for accuracy of pre-operative imaging in patient-specific instrumentation. We recommend CT as a more favourable option at present due to reduced scanning times, increased availability, and relatively cheaper cost.