Comparison of Total Knee Arthroplasty Using Computer-Assisted Navigation versus Conventional Guiding Systems: A Prospective Study

Pang, CH; Chan, WL; Yen, CH; Cheng, SC; Woo, Sook Bin; Choi, Soo Kyoung; Hui, WK; Mak, Koon Hou

doi:10.1177/230949900901700209

Cited by 48 publications

(38 citation statements)

References 27 publications

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“…The most commonly used method of setting coronal component alignment in TKA is an extramedullary tibial and an intramedullary femoral alignment guide, but this method has shown a limited degree of accuracy [2,3,5,21,30]. Although computer-assisted surgical techniques have consistently demonstrated improved alignment accuracy versus standard guides [3,13,16,19,27,32], the increased capital costs, operative times, learning curve, and unproven functional benefits associated with their use have limited their widespread acceptance [9].…”

Section: Introductionmentioning

confidence: 99%

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Nam

Park

Stambough

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Custom cutting guides (CCGs; sometimes called patient-specific instrumentation [PSI]) in total knee arthroplasty (TKA) use preoperative three-dimensional imaging to fabricate cutting blocks specific to a patient's native anatomy. Questions/purposes The purposes of this study were to determine if CCGs (1) improve clinical outcomes as measured by UCLA activity, SF-12, and Oxford knee scores; and (2) coronal mechanical alignment versus standard alignment guides. Methods This was a retrospective cohort study of patients undergoing primary TKA using the same cruciate-retaining, cemented TKA system between January 2009 and April 2012. Patients were included if they were candidates for a unilateral, cruciate-retaining TKA and met other prespecified criteria; patients were allowed to self-select either an MRI-based CCG procedure or standard TKA. Ninety-seven of 120 (80.8%) patients in the standard and 104 of 124 (83.9%, p = 0.5) in the CCG cohort with a minimum of 1-year followup were available for analysis. The first 95 patients in the standard (mean followup, 3 years; range, 1-4 years) and CCG (mean followup, 2 years; range, 1-4 years) cohorts were compared. The alignment goal for all TKAs was a hip-knee-ankle (HKA) angle of 0°. UCLA, SF-12, and Oxford knee scores were collected preoperatively and at each patient's most recent followup visit. Postoperative, rotationally controlled coronal scout CT scans were used to measure HKA alignment. Independent-sample t-tests and chi-square tests were used

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Section: Introductionmentioning

confidence: 99%

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Nam

Park

Stambough

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The prerequisites for stable positioning of an implant are restoring neutral limb alignment and establishing adequate soft tissue balance [3,4]. Malalignment may be related to pain, stiffness, instability, wear, osteolysis and increased risk of loosening [5][6][7][8]. It has been demonstrated that a varus or valgus malalignment of the mechanical axis of the operated limb > 3°is associated with up to 20 % higher incidence of implant loosening [9,10].…”

Section: Introductionmentioning

confidence: 99%

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare radiological results of total knee arthroplasties (TKAs) performed with patient-specific computed tomography (CT)-based instrumentation and conventional technique. The main study hypothesis was that CT-based patient-specific instrumentation (PSI) increases the accuracy of TKA. Methods A prospective, randomized controlled trial was carried out between January and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients operated on with the aid of the Signature™ CT-based implant positioning system. The control group consisted of 60 patients operated on using conventional instrumentation. The radiographic evaluation of implant positioning and overall coronal alignment was performed 12 months after the surgery by using standing anteroposterior radiographs of the entire lower limb and standard lateral radiographs. Results Of the 112 patients initially enrolled for the study, 95 were included in the subsequent analyses. There were no statistically significant differences between groups in respect to coronal and sagittal component positioning and overall coronal alignment, except for frontal tibial component positioning. For this parameter, better results were obtained in the control group, with borderline statistical significance. Conclusions Our study did not reveal superiority of the CTbased PSI system over conventional instrumentation. Further high-quality investigations of patient-specific systems are absolutely indispensable to assess their utility for TKA. In our opinion, the surgeon applying PSI technology is required to have advanced knowledge and considerable experience with the conventional method.

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“…The majority of orthopaedic surgeons continue to strive for neutral, postoperative mechanical alignment; however, this objective remains elusive with conventional intramedullary and extramedullary cutting guides demonstrating difficulty in reproducing this target reliably [9,17,18,24].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Sassoon

Nam

Nunley

et al. 2015

Clinical Orthopaedics &Amp; Related Research

179

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Background Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions. Questions/purposes We asked: (1) Do patient-specific cutting blocks achieve neutral mechanical alignment more reliably during TKA when compared with conventional methods? (2) Does patient-specific instrumentation (PSI) provide financial benefit through improved surgical efficiency? (3) Does the use of patient-specific cutting blocks translate to improved clinical results after TKA when compared with conventional instrumentation? Methods We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE 1 and EM-BASE 1 with respect to patient-specific cutting blocks and their effect on alignment, cost, operative time, clinical outcome scores, complications, and survivorship. Sixteen studies (Level I-III on the levels of evidence rubric) were identified and used in addressing the first question, 13 (Level I-III) for the second question, and two (Level III) for the third question. Qualitative assessment of the selected Level I studies was performed using the modified Jadad score; Level II and III studies were rated based on the Newcastle-Ottawa scoring system. Results The majority of studies did not show an improvement in overall limb alignment when PSI was compared with standard instrumentation. Mixed results were seen across studies with regard to the prevalence of alignment outliers when PSI was compared with conventional cutting blocks with some studies demonstrating no difference, some showing an improvement with PSI, and a single study showing worse results with PSI. The studies demonstrated mixed results regarding the influence of PSI on operative times. Decreased operative times were not uniformly observed, and when noted, they were found to be of minimal clinical or financial significance. PSI did reliably reduce the number of instrument trays required for processing perioperatively. The accuracy of the preoperative plan, generated by the PSI manufacturers, was found lacking, often leading to multiple intraoperative changes, thereby disrupting the flow of the operation and negatively impacting efficiency. Limited data exist with regard to the effect of PSI on postoperative function, improvement in pain, and patient

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Comparison of Total Knee Arthroplasty Using Computer-Assisted Navigation versus Conventional Guiding Systems: A Prospective Study

Abstract: Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.

Cited by 48 publications

References 27 publications

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

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