A Prospective, Randomized Study of Computer-Assisted and Conventional Total Knee Arthroplasty

Matziolis, Georg; Krocker, D.; Weiss, Ulrike; Tohtz, Stephan; Perka, Carsten

doi:10.2106/jbjs.f.00386

Cited by 376 publications

(248 citation statements)

References 20 publications

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“…This finding is also intuitive because surgeons would be able to place the cutting block independently of the anatomy whether a standard extramedullary guiding system or a navigation system is used. Numerous studies have documented the use of navigation improves alignment [12,22,24,28,34,37], but relatively few previous studies have addressed the issue of navigation in the context of the alignment of knees with severe deformity [12,22,24,28,34,37]. Our findings are generally in accord with two previous studies, which found that the use of navigation reduces outliers in knees with severe deformity [12,22,24,28,34,37].…”

Section: Discussionsupporting

confidence: 89%

“…Numerous studies have documented the use of navigation improves alignment [12,22,24,28,34,37], but relatively few previous studies have addressed the issue of navigation in the context of the alignment of knees with severe deformity [12,22,24,28,34,37]. Our findings are generally in accord with two previous studies, which found that the use of navigation reduces outliers in knees with severe deformity [12,22,24,28,34,37]. Furthermore, in the present study, the navigation group also had no outliers in femoral or tibial component alignment.…”

Section: Discussionmentioning

confidence: 99%

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Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

117

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Background Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear. Questions/purposes We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.Methods We measured alignment in 367 knees that underwent TKA and 60 sex-and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3°o r ± 2°) at 1 year. Results The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6°in the TKA group and valgus 1.1°in the control group, and mean tibial plateau inclination was varus 8.3°in the TKA group and varus 5.4°in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers. Conclusions Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

117

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“…However, some authors agree this objective may not be practically obtainable in every TKA [15]. Satisfactory position of a TKA prosthesis is commonly accepted to be an alignment within 3°from this ideal [1,6,7,12,17,18,22,23,28,33]. Aseptic loosening of the prosthesis has been reported to be more common in knees implanted in an alignment greater than 3°varus [26].…”

Section: Introductionmentioning

confidence: 99%

“…If an outlier in the lower limb mechanical alignment is defined as greater than 3°from the neutral position, the majority of the TKA series performed using the conventional jig-based technique reported a satisfactory alignment rate of approximately 70% [1-3, 5-10, 12, 13, 16-24, 28, 29, 31-34]. However, the results of most of the computer navigation TKA series were much more favorable, reporting satisfactory alignment of 90% to 100% [1,17,22,23,28,29,34]. Some surgeons have suggested this improved predictability of postoperative radiographic alignment with computer navigation TKA occurs with experienced and inexperienced surgeons [30].…”

Section: Introductionmentioning

confidence: 99%

“…Because many studies regarding this subject have been performed in high-volume tertiary referral centers, there is concern whether similarly good results can be obtained by the average orthopaedic surgeon [3]. Despite the fact that radiographic alignment of the implanted prosthesis is superior in computer navigation TKA, outliers greater than 3°are still unavoidable in most of the reported series [1,7,8,12,17,22,23]. The potential reasons leading to these outliers are not discussed in adequate detail in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Yau

Chiu

Zuo

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Postoperative alignment of the implanted prosthesis in computer-navigated TKA has been reported to be superior to that using the conventional technique. There is an assumption that use of computer navigation techniques can make an inexperienced or occasional TKA surgeon perform more like an expert TKA surgeon. To assess improved accuracy in recreation of mechanical alignment in TKA performed using computer navigation, a retrospective review of the experience of one of the authors (WPY) before and after using computer navigation was performed. We reviewed the radiographic results of 104 TKAs (52 computer navigation, 52 conventional technique) and found the accuracy of postoperative radiographic alignment of the implanted prosthesis was not improved by using computer navigation as judged by (1) overall limb alignment (case: varus 1.3°; control: varus 0.3°); (2) femoral component alignment (case: 90.3°; control: 90.3°); and (3) tibial component alignment (case: 89°; control: 90°). Significant factors that affected postoperative overall mechanical alignment in the current navigation series included severity of the preoperative deformity, amount of error in making bone cuts, and experience of the surgeon in using the computer navigation system. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Knee stability before and after total and unicondylar knee replacement: In vivo kinematic evaluation utilizing navigation

Casino

Martelli

Zaffagnini

et al. 2008

Journal Orthopaedic Research

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Surgical navigation systems are currently used to guide the surgeon in the correct alignment of the implant. The aim of this study was to expand the use of navigation systems by proposing a surgical protocol for intraoperative kinematics evaluations during knee arthroplasty. The protocol was evaluated on 20 patients, half undergoing unicondylar knee arthroplasty (UKA) and half undergoing posterior-substituting, rotating-platform total knee arthroplasty (TKA). The protocol includes a simple acquisition procedure and an original elaboration methodology. Kinematic tests were performed before and after surgery and included varus/valgus stress at 0 and 308 and passive range of motion. Both UKA and TKA improved varus/valgus stability in extension and preserved the total magnitude of screw-home motion during flexion. Moreover, compared to preoperative conditions, values assumed by tibial axial rotation during flexion in TKA knees were more similar to the rotating patterns of UKA knees. The analysis of the anteroposterior displacement of the knee compartments confirmed that the two prostheses did not produce medial pivoting, but achieved a postoperative normal behavior. These results demonstrated that proposed intraoperative kinematics evaluations by a navigation system provided new information on the functional outcome of the reconstruction useful to restore knee kinematics during surgery. ß

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A Prospective, Randomized Study of Computer-Assisted and Conventional Total Knee Arthroplasty

Cited by 376 publications

References 20 publications

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Knee stability before and after total and unicondylar knee replacement: In vivo kinematic evaluation utilizing navigation

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