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

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

doi:10.2106/00004623-200702000-00002

Cited by 64 publications

(77 citation statements)

References 23 publications

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“…21,22 The longterm success of TKA depends on patient characteristics, the type of implant, the operative technique adopted, and accurate positioning of the prosthetic components, especially rotational alignment. 7,8,11 Proper cutting of the femoral condyles and tibial plates is an extremely time-consuming phase of TKA that attempts to perform in the operating room what was previously established in preoperative planning. This is necessary to obtain correct positioning of implants.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, implant malpositioning with conventional instrumentation can reach a rate of 20% to 40%, even at most experienced centers. [11][12][13] Computer-assisted navigation systems limit implant malpositioning, reducing the number of outliers. However, potential disadvantages include difficulty with registration of intraoperative landmarks, longer operative time, increased costs, pin loosening and pin-site fractures, a long learning curve, and poor accuracy in determining the rotational alignment of implants.…”

Section: Implant Positioning In Tka: Comparison Between Conventional mentioning

confidence: 99%

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Implant Positioning in TKA: Comparison Between Conventional and Patient-Specific Instrumentation

Ferrara¹,

Cipriani²,

Magarelli³

et al. 2015

Orthopedics

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The number of total knee arthroplasty (TKA) procedures continuously increases, with good to excellent results. In the last few years, new surgical techniques have been developed to improve prosthesis positioning. In this context, patient-specific instrumentation is included. The goal of this study was to compare the perioperative parameters and the spatial positioning of prosthetic components in TKA procedures performed with patient-specific instrumentation vs traditional TKA. In this prospective comparative randomized study, 15 patients underwent TKA with 3-dimensional magnetic resonance imaging (MRI) preoperative planning (patient-specific instrumentation group) and 15 patients underwent traditional TKA (non-patient-specific instrumentation group). All patients underwent postoperative computed tomography (CT) examination. In the patient-specific instrumentation group, preoperative data planning regarding femoral and tibial bone resection was correlated with intraoperative measurements. Surgical time, length of hospitalization, and intraoperative and postoperative bleeding were compared between the 2 groups. Positioning of implants on postoperative CT was assessed for both groups. Data planned with 3-dimensional MRI regarding the depth of bone cuts showed good to excellent correlation with intraoperative measurements. The patient-specific instrumentation group showed better perioperative outcomes and good correlation between the spatial positioning of prosthetic components planned preoperatively and that seen on postoperative CT. Less variability was found in the patient-specific instrumentation group than in the non-patient-specific instrumentation group in spatial orientation of prosthetic components. Preoperative planning with 3-dimensional MRI in TKA has a better perioperative outcome compared with the traditional method. Use of patient-specific instrumentation can also improve the spatial positioning of both prosthetic components.

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Section: Discussionmentioning

confidence: 99%

Section: Implant Positioning In Tka: Comparison Between Conventional mentioning

confidence: 99%

Implant Positioning in TKA: Comparison Between Conventional and Patient-Specific Instrumentation

Ferrara¹,

Cipriani²,

Magarelli³

et al. 2015

Orthopedics

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show abstract

“…The mechanical axis of the limb in the coronal plane is the most commonly reported alignment parameter, and the overall postoperative limb alignment should be corrected within 0 AE 3 degrees of the mechanical axis according to the previous studies. [8][9][10] The mechanical axis of the limb was defined as the one line drawn from the center of the femoral head to the deepest part of the femoral notch at the knee, with a second line drawn from the midpoint of the tibial plateau to the midpoint of the inner extension of the tibiotalar joint. 11 Mechanical alignment (MA) in TKA is to place the femoral and tibial components perpendicular to the mechanical axis and align the hip-knee-ankle angle of the limb to neutral position to balance load distribution between the medial and lateral compartments and reduce the wear and component loosening.…”

mentioning

confidence: 99%

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

Wang

et al. 2017

J Knee Surg

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This meta-analysis was conducted to study whether kinematically aligned total knee arthroplasty (TKA) improves short-term functional outcomes compared with mechanical alignment without changing the hip-knee-ankle angle. Prospective cohort studies were searched from electronic literature databases, including PubMed, Web of Science, Embase (Ovid interface), and Cochrane Library (Ovid interface). Total 1,159 records were identified. Six trials involving 561 patients were eligible for data extraction and meta-analysis. The included studies recorded outcomes in the follow-up range from 6 to 34 months. Primary outcomes were to assess the functional outcomes in follow-up, and KA group achieved better performance on WOMAC score (mean difference [MD] = -18.82, 95% CI: -16.06 to -5.58), knee function score (MD = 7.23, 95% CI: 0.52-13.94), Oxford knee score (MD = 4.76, 95% CI: 0.40-9.12), and knee range of flexion (MD = 4.48, 95% CI: 2.09-6.86), whereas other parameters including Knee Society score, knee range of extension, VAS pain score, and the occurrence of the complications were without significant difference ( > 0.05). Second outcomes evaluated the perioperative clinic indexes. Our meta-analysis showed that KA group had a shorter time of operation (MD = -15.44, 95% CI: -27.47 to -3.71) and a longer walk distance before discharge (MD = 53.24, 95% CI: 21.32-85.15) when compared with the MA group, whereas the change in hemoglobin, incision length, knee range of flexion before discharge, and length of stays were without significant difference ( > 0.05). Third outcomes were used to analyze the alignment data. Our study showed that KA had larger angles of femoral component and mechanical axis of the femur (MD = -1.95,95% CI: -2.77 to -1.13), tibial component and mechanical axis of tibia (MD = 2.06, 95% CI: 1.43-2.70), anatomic knee angle (MD = -0.72, 95% CI: -1.33 to -0.11), and operative limb alignment (MD = -1.97, 95% CI: -2.50 to -1.45,) compared with the MA group, but the hip-knee-ankle angles between the two groups were similar. KA provided better functional outcomes and better flexion following short-term follow-up of TKA. However, longer-term follow-up and larger sample studies are needed to put into research in the future.

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“…The majority of these were externally rotated. The accuracy of femoral rotation alignment is higher than conventional TKR and within range or better than computer‐assisted TKR . These results demonstrate that PSJ instrumentation can reduce the variability in femoral rotational alignment seen previously with conventional and navigated TKAs principally because it utilizes an image‐based selection of the anatomical landmarks rather than relying on surgeon selection of these landmarks intraoperatively.…”

Section: Discussionmentioning

confidence: 72%

Component position alignment with patient-specific jigs in total knee arthroplasty

2014

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

Cited by 64 publications

References 23 publications

Implant Positioning in TKA: Comparison Between Conventional and Patient-Specific Instrumentation

Implant Positioning in TKA: Comparison Between Conventional and Patient-Specific Instrumentation

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

Component position alignment with patient-specific jigs in total knee arthroplasty

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