Comparison of a novel handheld accelerometer-based navigation system and conventional instrument for performing distal femoral resection in total knee arthroplasty: a randomized controlled trial

Abstract

Background: This prospective study aimed to compare the efficacy of a novel, hand-held, accelerometerbased navigation system (i-JOIN knee navigation system) for distal femoral resection in total knee arthroplasty (TKA) with conventional instrument.Methods: A multi-center, double-blinded, randomized controlled trial (RCT) was conducted. A total of 79 consecutive patients scheduled for primary TKA were enrolled and divided into navigation group (39 patients) and conventional group (40 patients). Post-operative mechanical and component position were evaluated through full-leg weight bearing X-ray. Pre-operatively and 1 week post-operatively, adverse events were recorded. Intraoperative surgical time and blood loss were also recorded. Results:The mean outlier of 180° neutral mechanical axis was 1.60° (SD 1.11°) in navigation group and 2.30° (SD 2.06°) in conventional group (P=0.0917). Thirty-eight patients (97.4%) in navigation group and 35 patients (87.5%) in conventional group had an alignment which was ≤3°away from the neutral mechanical axis (P=0.2007). α angle between the navigation group and conventional group was not statistically different (89.81° vs. 89.76°, P>0.05), as well as adverse events rate post-operatively. The operative time of navigation group was significantly longer than that of control group (114.54±35.34 vs. 100.33±28.38 min, P=0.0493), whereas the intraoperative blood loss was not significantly different.Conclusions: i-JOIN knee navigation system had equivalent results for distal femoral resection in TKA compared with the conventional technique.

Current role of handheld navigation system in total knee arthroplasty: where we are?

“…Alike the results of previous different kind of handheld navigation systems (16)(17)(18)(19)(20), the coronal femur alignments in this handheld navigation were not significantly different compared to that of a conventional system, although the postoperative mechanical axis seemed to be close to neutral alignment and the number of outliers more than 3° were found less frequently in the handheld navigation group. However, the surgical time in a study by Xu et al (15) was still longer in a handheld navigation group than a conventional group, and it was similar to the results of a recent meta-analysis (16). Hence, there are still limitations including increased surgical time, lack of information for soft tissue balancing and rotational alignment, and lack of cost-effectiveness in terms of clinical outcomes when using a handheld navigation system (16).…”

“…To address these limitations, the handheld navigation systems were introduced with the advantages of shorter learning curve periods, no transosseous tracker pins, no need to ream the femoral/tibial canal, no optical tracking which might be affected by conditions in the operating room, and similar instrumentation to conventional TKAs. Xu et al (15) reported the results of TKA using a novel handheld accelerometer-based navigation system called i-JOIN. Alike the results of previous different kind of handheld navigation systems (16)(17)(18)(19)(20), the coronal femur alignments in this handheld navigation were not significantly different compared to that of a conventional system, although the postoperative mechanical axis seemed to be close to neutral alignment and the number of outliers more than 3° were found less frequently in the handheld navigation group.…”

Usefulness of an accelerometer-based navigation system in bilateral one-stage total knee arthroplasty

“…Prior studies have revealed that ABN can reduce estimate blood loss and Hb dropping after surgery compared to conventional TKA [ 11 , 12 ]. Ikawa et al [ 10 ] conducted a prospective RCT study and reported that 121 unilateral ABN assisted TKA had 287 ml less average blood loss than 120 unilateral conventional TKA ( p < 0.05).…”

“…Goh et al [ 9 ] demonstrated that ABN has a comparable number of outliers for the mechanical axis (MA) and coronal prostheses orientation, as compared to non CT-based CAS. In addition to improving limb alignment, another possible benefit using ABN in BTKA is that it may cause less endothelial and microvascular damage by avoiding intramedullary disturbance, and may result in less post-operative hemarthrosis and blood loss, less inflammation, lower postoperative pain intensity, and reduced potential risks related to marrow embolism [ 7 , 10 , 11 ]. Kawaguchi et al [ 12 ] retrospectively reviewed 64 patients who underwent conventional unilateral TKA (32 patients) and ABN assisted TKA (32 patients).…”

Total knee arthroplasty in the next decade: is navigation necessary?

“…In a recent issue of the Annals of Translational Medicine, Xu et al conducted a double-blind, prospective randomized study investigating the accuracy of a new ABN system known as the i-JOIN knee navigation system (i-JOIN Medical Technology, Shanghai) (9). A total of 39 patients had the femoral resection performed with the use of the i-JOIN ABN device, while 40 patients underwent surgery using a conventional intramedullary guide.…”