Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial

Yan, Chun Hoi; Chiu, K. Y.; Ng, Florrie Fei Yin; Chan, Ping Keung; Fang, Christian

doi:10.1007/s00167-014-3264-2

Cited by 61 publications

(84 citation statements)

References 41 publications

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“…The application of EM technique was associated with minimal invasiveness since the femoral canal was not breached and the blood loss could be reduced by 145–396 mL [8, 14, 27–29]. Computer-assisted TKA and patient-specific instrumentation (PSI) were recently introduced with the aim of improving alignment without violating the femoral canal [30–32]. TKA using PSI did not result in significantly better femoral component alignment in the sagittal and axial planes than TKA using conventional instrumentation [32].…”

Section: Discussionmentioning

confidence: 99%

“…Computer-assisted TKA and patient-specific instrumentation (PSI) were recently introduced with the aim of improving alignment without violating the femoral canal [30–32]. TKA using PSI did not result in significantly better femoral component alignment in the sagittal and axial planes than TKA using conventional instrumentation [32]. However, the blood loss was significantly reduced by using the PSI system compared with the IM system for femoral cut.…”

Section: Discussionmentioning

confidence: 99%

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Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials

et al. 2017

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BackgroundThere is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty. The aim of this study was to compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for lower limb alignment, blood loss, and operative time during total knee arthroplasty.MethodsThe Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Chinese Periodical, Google, and reference lists of all the included studies were searched for randomized controlled trials. The following parameters were compared between the extramedullary technique and the intramedullary technique: (1) lower limb coronal alignment, (2) coronal alignment of femoral component, (3) sagittal alignment of femoral component, (4) blood loss, (5) and operation time.ResultsFour randomized controlled trials consisting of 358 knees were included in our study. There was no significant difference between the extramedullary and intramedullary groups for the lower limb coronal alignment (RR = 1.20, 95%CI 0.28~5.21, n.s.), coronal alignment of femoral component (RR = 0.65, 95%CI 0.19~2.22, n.s.), and sagittal alignment of femoral component (RR = 0.73, 95%CI 0.38~1.41, n.s.). A reduced blood loss was associated with the use of the extramedullary guide (MD = −120.34, 95%CI −210.08~−30.59, P = 0.009). No significant difference in operation time was noted between the two groups (MD = 1.41, 95%CI −1.82~4.64, n.s.).ConclusionsNeither extramedullary nor intramedullary femoral alignment is more accurate than the other in facilitating the femoral cut in total knee arthroplasty. Use of the extramedullary guide results in less blood loss and exhibits a similar operation time as compared with the intramedullary guide.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0582-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials

et al. 2017

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“…Several reasons have been suggested to explain this, such as risk of infections and fractures related to tracker fixation and increasing time of surgery [17], [18]. It is clear that tracker setup and registration are both additional tasks that are not required when using manual instrumentation, and it has been shown that knee navigation increases the overall time of surgery in comparison to conventional TKA by up to 30 minutes [1], [5], [6], [7], [8], [9], [10], [11], [26], [27]. The Smart software was developed to reduce registration and consequently overall operative time.…”

Section: Discussionmentioning

confidence: 99%

“…This is due to a number of criticisms including that it increases operation times and the risks of problems with the tracker bone screw insertion sites [1], [5], [6], [7], [8], [9], [10], [11].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have shown that the use of navigation increases operative time when compared to conventional instrumentation [1], [5], [6], [7], [8], [9], [10], [11], [12]. The increase in operation time is both due to the setup of the navigation system (including positioning the camera and bone pin fixation to mount trackers) and then undertaking the registration of the lower limb which involves collecting palpated anatomical landmarks and kinematic centers to allow the computer software to compute the patient's frame of reference and calculate lower limb position.…”

Section: Introductionmentioning

confidence: 99%

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A randomized controlled trial to compare component placement in navigated total knee arthroplasty using original and streamlined registration processes

et al. 2017

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BackgroundThis randomized controlled trial validated a redesigned version of navigated total knee arthroplasty software with a streamlined registration (Smart) against the previous version (Classic). The objectives were to determine if Smart software had the same accuracy of component positioning and whether registration and operative time were reduced.MethodsA total of 220 patients were recruited and had a navigated total knee arthroplasty performed. With the exception of the software, all patients had the same perioperative care. At 6-week follow-up with an independent arthroplasty service, all patients had a computerized tomography scan. This was assessed by an independent radiologist to measure the mechanical alignment of the components.ResultsThe mean postoperative mechanical femorotibial angles were equivalent between groups (mean difference −0.2°, 95% confidence interval −0.7° to 0.3°, P = .407). Component positions were similar in both groups. Mean registration time was significantly shorter for the Smart group (2 minutes 30 seconds ± 54 seconds) than the Classic group (3 minutes 23 seconds ± 39 seconds), P < .001. The mean operative time was 72 ± 12 minutes in both groups (P = .855). At 6-week follow-up, both groups had similar clinical outcomes with 96.5% of patients being satisfied or very satisfied.ConclusionsThe study verified that a reduced registration time did not alter the accuracy of component placement. However, despite a shorter registration time, the overall surgical time was not reduced.

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Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Siegel

Balach

Sweeney

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. Methods: Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. Results: Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. Conclusions: Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.

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Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial

Abstract: I.

Cited by 61 publications

References 41 publications

Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials

Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials

A randomized controlled trial to compare component placement in navigated total knee arthroplasty using original and streamlined registration processes

Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

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