Navigated Total Knee Arthroplasty for Osteoarthritis With Extra-Articular Deformity

Abstract

Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation.Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery.Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group.Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

Efficacy and safety of radiofrequency ablation for treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

“…Total knee arthroplasty is considered the treatment of choice for end-stage knee OA and can provide excellent postoperative pain relief, remarkable deformity correction, and satisfactory functional recovery. 3 , 4 However, not all patients are appropriate candidates for this treatment because of age, comorbidities, or other factors.…”

One-Stage Total Knee Arthroplasty Plus Corrective Osteotomy for Osteoarthritis Associated With Severe Extra-articular Deformity

“…There are several advantages of this computer-guided procedure: no additional incisions for the osteotomy, possibility of early rehabilitation, and it avoids complications that arise from the osteotomy such as delayed consolidation, internal fixation failure, and infection at osteotomy level (Fig 11). 5, 20, 21 Tani et al 22 . had better clinical outcomes in cases in which navigation was used compared with non-navigated TKA associated with EAD in a small size study.…”

Accelerometer-Based Navigation versus Conventional Total Knee Arthroplasty for Posttraumatic Knee Osteoarthritis

“…A case series of 40 PTOAs revealed that CAS could improve the lower limb alignment from 166.7° to 179.1° and increase KSKS and KSFS. 6) Tani et al 8) compared CAS and a conventional system and found that KSFS was significantly better (93.3 ± 5.9 vs. 73.6 ± 15.4, respectively; p = 0.008) with slightly better KSKS, prosthesis position, and MA. Nevertheless, Rhee et al 7) found a difference in MA between an intraoperative assessment by CAS and a postoperative weight-bearing radiograph.…”

“…Although a prospective, randomized study with a larger group of patients may help in verifying our findings, it may not be feasible because of the low incidence of PTOA. 8) Third, albeit a three-dimensional computed tomography scan can provide component rotatory information in the axial plane with higher measurement resolution, standing two-dimensional plain radiographs reflected the actual alignment under physiologic load, which could not be achieved with a CT scan. 34) Lastly, the follow-up duration of the present study was relatively short, and a longer follow-up period may be necessary to verify the clinical outcomes and actual cost-effectiveness of this ABN system in terms of implant survivorship.…”

“…Even though several studies published the good clinical results and radiographic outcomes using CAS in patients with PTOA, 6 7) there are a limited number of studies that compared CAS directly to the conventional technique. 8) Additionally, the accuracy of postoperative MA after CAS-TKA has been demonstrated to be associated with the preoperative degree of extra-articular deformity; deformity > 15° in the coronal plane yielded more outliers. 9) Furthermore, many surgeons still refrain from using the CAS because of its disadvantages including higher cost, steep learning curve, a complicated registration process, line-of-sight problem, and pin site-related complications.…”