Comparative Study of Pinless Navigation System versus Conventional Instrumentation in Total Knee Arthroplasty

Pawar, Prashant; Naik, Lokesh Gudda; Sahu, Dipit; Bagaria, Vaibhav

doi:10.4055/cios20226

Cited by 16 publications

(17 citation statements)

References 27 publications

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“…The patients were divided into 3 groups according to their WBL ratios 3 months after surgery. The hip-knee-ankle (HKA) angle was defined as the angle subtended by (1) a line drawn from the center of the femoral head to the center of the knee and (2) a line drawn from the center of the knee to the center of the talus on whole-leg standing radiographs, with positive and negative HKA angles indicating varus and valgus, respectively 25 (Figure 3A). The change in HKA angle from 3 months to 2 years postoperatively was calculated to determine the alignment changes.…”

Section: Methodsmentioning

confidence: 99%

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Am J Sports Med

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Background: Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs. Purpose: To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups. Results: Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score ( P = .002), Kujala score ( P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004). Conclusion: Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.

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Section: Methodsmentioning

confidence: 99%

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Am J Sports Med

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“…Thus, failure to restore the neutral mechanical axis leads to unfavorable clinical outcomes and prosthesis failure. However, several studies have reported a considerable proportion of outliers exceeding 3° from the neutral mechanical axis in c-TKA [12,23,24]. For the distal femoral cutting procedure, the system of IM referencing has been generally adopted in c-TKA.…”

Section: Discussionmentioning

confidence: 99%

Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in Asian patients: A prospective study

Jung,

Kang,

Lee

et al. 2022

Preprint

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Background Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve a more accurate implant position than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, there are few studies on Asians with different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. Methods This prospective study included 50 consecutive c-TKAs (C group), followed by 50 consecutive r-TKAs using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKAs. Accordingly, the r-TKA cases were divided into initial cases (I group) and proficiency cases (P group). Femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among all groups. Results r-TKA was associated with a learning curve for operative time in 18 cases. Operative time was significantly shorter in the C and P groups than in the I group, with no significant difference between the C and P groups. The I and P groups demonstrated fewer outliers regarding lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than the C group, with no significant difference between C and P groups. Conclusion Operative time was not significantly different between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant position with r-TKA in Asian patients regardless of the learning curve.

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“…The HKA angle was defined as the angle subtended by a line drawn from the center of the femoral head to the center of the knee and a line drawn from the center of the knee to the center of the talus on whole-leg standing radiographs, with a positive and negative HKA angle indicating varus and valgus, respectively 11 , 30 ( Figure 2 ). To investigate the gradual changes in the HKA angle, we measured this angle at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.

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Comparative Study of Pinless Navigation System versus Conventional Instrumentation in Total Knee Arthroplasty

Cited by 16 publications

References 27 publications

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in Asian patients: A prospective study

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

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