• Xiang-Dong Wu, Bing-Yan Xiang, Schotanus Martijn G M MGM Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, 6162 BG, The Netherlands., Zun-Han Liu, Yu Chen, and Wei Huang.
• Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; Evidence-Based Perioperative Medicine 07 Collaboration Group, China.
• Surg J R Coll Surg E. 2017 Dec 1; 15 (6): 336-348.

BackgroundTo determine whether computed tomography (CT) or magnetic resonance imaging (MRI) is more suitable for the patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA).MethodsPubMed, Embase, and the Cochrane Library were searched from inception to June 2016 for prospective comparative trials that compared CT- versus MRI-based PSI systems for TKA. Our predefined primary outcome was the outliers incidence of coronal overall limb alignment.ResultsSix studies with a total of 336 knees meeting the eligibility criteria, and four trials were included in the meta-analysis. Compared with MRI-based PSI systems, CT-based PSI systems were associated with a higher outliers incidence of coronal overall limb alignment (risk ratio: 1.67; 95% confidence interval (CI): 1.03-2.72; P = 0.04), more angular errors of coronal overall limb alignment (mean difference (MD): 1.01°; 95% CI: 0.47-1.56; P = 0.0003), and longer operation time (MD: 5.02 min; 95% CI: 1.26-8.79; P = 0.009). While no significant differences in the coronal/sagittal alignment of the femoral/tibial component outliers, the angular errors of coronal overall limb alignment, the angular errors of the femoral/tibial component in coronal plane, or incidence of change of implant size of the femoral/tibial component were observed.ConclusionsThe current limited evidence suggests that MRI-based PSI systems exhibit higher accuracy for TKA regarding the coronal limb axis than CT-based PSI systems. However, well-designed studies comparing CT-versus MRI-based PSI systems for TKA are warrant to confirm these results before widespread use of this technique can be recommended.Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

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