Leg length discrepancy following total hip replacement (THR) can contribute to poor hip function. Abnormal gait, pain, neurological disturbance and patient dissatisfaction have all been described as a result of leg length inequality after THR. The purpose of this study was to determine whether the use of computer navigation in THR can improve limb length restoration and early clinical outcomes. We performed a matched-pair study comparing 48 computer-assisted THR with 48 THRs performed using a traditional freehand alignment method. The same implant with a straight non-modular femoral stem was used in all cases. The navigation system used allowed the surgeon to monitor both acetabular cup placement and all the phases of femoral stem implantation including rasping. Patients were matched for age, sex, arthritis level, pre-operative diagnosis and pre-operative leg length discrepancy. At a minimum follow-up of six months, limb length discrepancy was measured using digital radiographs and a standardised protocol. The number of patients with a residual discrepancy of 10 mm or more and/or a postoperative over-lengthening were measured. The clinical outcome was evaluated using both the Harris Hip Score and the normalised Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Restoration of limb length was significantly better in the computerassisted THR group. The number of patients with a residual limb length discrepancy greater than 10 mm and/or a post-operative over-lengthening was significantly lower. No significant difference in the Harris Hip Score or normalised WOMAC Arthritis Index was seen between the two groups. The surgical time was significantly longer in the computer-assisted THR group. No post-operative dislocations were seen.

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Patients older than 60 with unicompartmental knee arthritis can be treated with total or unicompartmental knee replacement. The aim of this study was to compare the results of matched paired groups of patients with isolated medial compartment knee arthritis replaced with either UKR (group A) or computer-assisted TKR (group B). The results included 68 knees at a minimum follow-up of 3 years. All patients had a varus deformity no greater than 8º and a BMI lower than 30. Patients were matched in terms of preoperative arthritis severity, age, gender and preoperative range of motion. In the computer-assisted TKR group, all the implants were positioned within 4º of the correct hip-knee-ankle angle and frontal tibial component angle. The surgical time and hospital stay were statistically longer in the CA TKR group. During the study no implant required revision. The results showed higher scores for a UKR in the treatment of isolated primary unicompartmental knee arthritis in patients older than 60 compared to a computer-assisted TKR. In this study a computer-assisted alignment system for TKR with optimal implant positioning did not produce equivalent clinical results compared to a UKR, but did increase the financial costs.Résumé Les patients âgés de plus de 60 ans, présentant une arthrose unicompartimentale du genou ont été traités soit par une prothèse totale, soit par une prothèse unicompartimentale. Le but de cette étude est de comparer les résultats de patients présentant une arthrose fémoro tibiale interne traités par une prothèse unicompartimentale (groupe A), ou par prothèse totale du genou mise en place par chirurgie assistée par ordinateur (groupe B). Les résultats incluent 68 genoux avec un suivi minimum de 3 ans. Tous les patients avaient une déformation en varus inferiure à 8 degrés et un BMI inférieur à 30. Les patients ont été comparés en fonction du degré d'arthrose, de l'âge, du sexe et de la mobilité pré opératoire. Dans la série prothèse totale, tous les implants ont été positionnés avec une marge de 4°par rapport à l'angle hanche cheville. Le temps opératoire et la durée d'hospitalisation ont été statistiquement plus importants dans le groupe prothèse totale. Aucun implant n'a nécessité de révision. Les résultats montrent que le score est bien meilleur dans les prothèses unicompartimentales pour le traitement des arthroses unicompartimentales, chez ces patients âgés de plus de 60 ans, comparé au traitement par prothèse totale avec chirurgie assistée par ordinateur. Cette étude montre que la mise en place par chirurgie assistée par ordinateur d'une prothèse totale du genou avec un positionnement optimal des implants peut donner un résultat équivalent à celui des prothèses unicompartimentales mais augmente le coût financier du traitement. IntroductionRecent trends in knee reconstructive surgery have included less invasive surgical approaches along with preserving

Purpose The aim of this study was to retrospectively compare the results of two matched-paired groups of patients who had undergone a medial unicompartmental knee arthroplasty (UKA) performed using either a conventional or a nonimage-guided navigation technique specifically designed for unicompartmental prosthesis implantation. Methods Thirty-one patients with isolated medialcompartment knee arthritis who underwent an isolated navigated UKA were included in the study (group A) and matched with patients who had undergone a conventional medial UKA (group B). The same inclusion criteria were used for both groups. At a minimum of six months, all patients were clinically assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) index. Radiographically, the frontal-femoral-component angle, the frontal-tibial-component angle, the hip-knee-ankle angle and the sagittal orientation of components (slopes) were evaluated. Complications related to the implantation technique, length of hospital stay and surgical time were compared. Results At the latest follow-up, no statistically significant differences were seen in the KSS, function scores and WOMAC index between groups. Patients in group B had a statistically significant shorter mean surgical time. Tibial coronal and sagittal alignments were statistically better in the navigated group, with five cases of outliers in the conventional alignment technique group. Postoperative mechanical axis was statistically better aligned in the navigated group, with two cases of overcorrection from varus to valgus in group B. No differences in length of hospital stay or complications related to implantation technique were seen between groups. Conclusion This study shows that a specifically designed UKA-dedicated navigation system results in better implant alignment in UKA surgery. Whether this improved alignment results in better clinical results in the long term has yet to be proven.

Computer-assisted total knee replacement (TKR) has been shown to improve radiographic alignment. Continuous feedback from the navigation system allows accurate adjustment of the bone cuts, thus reducing errors. The aim of this study was to determine the impact of experience both with computer navigation and knee replacement surgery on the frequency of errors in intraoperative bone cuts and implant alignment. Three homogeneous patient groups undergoing computer assisted TKR were included in the study. Each group was treated by one of three surgeons with varying experience in computer-aided and knee replacement surgery. Surgeon A had extensive experience in knee replacement and computer-assisted surgery. Surgeon B was an experienced knee replacement surgeon. A general orthopaedic surgeon with limited knee replacement surgery experience performed all surgeries in group C. The cutting errors and the number of re-cuts were determined intraoperatively. The complications and mean surgical time were collected for each group. The postoperative frontal femoral component angle, frontal tibial component angle, hip-knee-ankle angle and component slopes were evaluated. The results showed that the number of cutting errors were lowest for TKR performed by the surgeon with experience in navigation. This difference was statistically significant when compared to the general orthopaedic surgeon. A statistically significant superior result was achieved in final mechanical axis alignment for the surgeon experienced in computerguided surgery compared to the other two groups (179.3°c ompared to 178.9°and 178.1°). However, the total number of outliers was similar, with no statistically significant differences among the three surgeons. Experience with navigation significantly reduced the surgical time.

We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed 53 years earlier to treat septic arthritis. The fracture was treated successfully using a double-plating technique with 4.5 mm titanium reconstruction plates.

Fracture of the metallic components is a potential cause of failure of unicompartmental knee arthroplasty. In our experience, the incidence of this complication was 4.9 % of all UKR failures. Patients with a BMI greater than 30 and a progressive deterioration in limb alignment were at greater risk.