Computer assistance in total knee replacement – a critical assessment of current health care technology

Lüring, C.; Bäthis, H.; Tingart, Markus; Perlick, L.; Grifka, Joachim

doi:10.1080/10929080600578925

Cited by 8 publications

(13 citation statements)

References 3 publications

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“…Recently, several studies have shown improved alignment of knee prostheses when using either CT-free or CT-based computer assisted orthopaedic surgery (CAOS) [1, 2, 4, 6, 13, 17, 24]. Although the placement accuracy has been proven to be higher using this technique, ultimately initial progressive micromotion of a TK as measured with RSA is of more importance, since this is indicative of future prosthesis survival [13, 23, 26].…”

Section: Introductionmentioning

confidence: 99%

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Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component

Strien

Zwaag

Kaptein

et al. 2008

International Orthopaedics (SICOT)

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We evaluated the influence of CT-free or CT-based computer assisted orthopaedic surgery (CAOS) on the alignment of total knee prostheses (TK) and micromotion of tibial components. This randomised study compared 19 CTfree, 17 CT-based CAOS TK, and a matched control group of 21 conventionally placed TK. Using Roentgen stereophotogrammetric analysis (RSA) the migration was measured. The alignment and component positions were measured on radiographs. No significant difference in leg and tibial component alignment was present between the three groups. A significant difference was found for micromotion in subsidence, with the conventional group having a mean of 0.16 mm, compared to the CT-free group at 0.01 mm and the CT-based group at −0.05 mm. No clinical significant difference in alignment was found between CAOS and conventionally operated TK. More subsidence of the tibial component was seen in the conventional group compared to both CAOS groups at two year follow-up.

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Section: Introductionmentioning

confidence: 99%

“…Although the placement accuracy has been proven to be higher using this technique, ultimately initial progressive micromotion of a TK as measured with RSA is of more importance, since this is indicative of future prosthesis survival [13, 23, 26]. …”

Section: Introductionmentioning

confidence: 99%

Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component

Strien

Zwaag

Kaptein

et al. 2008

International Orthopaedics (SICOT)

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“…Several authors have reported improved alignment and better component positioning with computer-assisted surgery (CAS) (Chauhan et al. 2004, Lüring et al. 2006, Dyrhovden et al.…”

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confidence: 99%

Similar migration in computer-assisted and conventional total knee arthroplasty

et al. 2016

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Background and purposeComputer-assisted surgery (CAS) in total knee arthroplasty (TKA) has been used in recent years in the hope of improving the alignment and positioning of the implant, thereby achieving a better functional outcome and durability. However, the role of computer navigation in TKA is still under debate. We used radiostereometric analysis (RSA) in a randomized controlled trial (RCT) to determine whether there are any differences in migration of the tibial component between CAS- and conventionally (CONV-) operated TKA.Patients and methods54 patients (CAS, n = 26; CONV, n = 28) with a mean age of 67 (56–78) years and with osteoarthritis or arthritic disease of the knee were recruited from 4 hospitals during the period 2009–2011. To estimate the mechanical stability of the tibial component, the patients were examined with RSA up to 24 months after operation. The following parameters representing tibial component micromotion were measured: 3-D vector of the prosthetic marker that moved the most, representing the magnitude of migration (maximum total point motion, MTPM); the largest negative value for y-translation (subsidence); the largest positive y-translation (lift-off); and prosthetic rotations. The precision of the RSA measurements was evaluated and migration in the 2 groups was compared.ResultsBoth groups had most migration within the first 3 months, but there was no statistically significant difference in the magnitude of the migration between the CAS group and the CONV group. From 3 to 24 months, the MTPM (in mm) was 0.058 and 0.103 (p = 0.1) for the CAS and CON groups, respectively, and the subsidence (in mm) was 0.005 and 0.011 (p = 0.3).InterpretationMean MTPM, subsidence, lift-off, and rotational movement of tibial trays were similar in CAS- and CONV-operated knees.

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“…As a consequence of that, literature devoted to the use of computer‐assisted surgery in TKR has mainly focused on the achievement of a correct axial alignment in comparison with conventional instrumentation …”

Section: Introductionmentioning

confidence: 99%

“…3,5 As a consequence of that, literature devoted to the use of computer-assisted surgery in TKR has mainly focused on the achievement of a correct axial alignment in comparison with conventional instrumentation. 5,9,10 Other authors suggest that computer-assisted surgery is not able to add significant improvements on the final position of the knee implants. 11 These nonunivocally positive results together with increased operative time, costs, 12,13 and a prolonged learning curve 14 due to the procedure complexity have been a limiting factor to the routine use of the computer-assisted procedures in TKR.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative validation of bone cut accuracy of a pinless smart touch‐screen navigation system device in total knee arthroplasty

Ulivi

Orlandini

Meroni

et al. 2019

Robotics Computer Surgery

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Purpose Primary objective in most of the published literature on computer‐assisted total knee arthroplasty (TKA) has so far been the comparison of axial alignment and components position, obtained either through navigation systems or through conventional instrumentation. We have found no studies aimed at assessing the intraoperative reliability of a navigation system in relation to bone cuts height. Aim of our study was therefore to establish bone cut accuracy of a pinless navigation system. Methods From January 2014 to February 2016, 44 consecutive patients requiring total knee replacement (TKR) were enrolled in a prospective study. Primary end point of the study was to assess the accuracy of the DASH iPOD TOUCH Navigation System (Brainlab AG, Feldkirchen, Germany) by measuring the real thickness of both tibial and femoral osteotomies. We compared the data indicated by the navigation system with the intraoperative anatomical measurements done with the aid of a caliper. In addition, the radiographic alignment was compared with the data derived from the navigator. Results The device proved to be precise. Differences between the two methods of measurement are distributed over a millimeter range. Radiological measurements showed that 95.5% of tibial components were within the range of 3° varus/valgus; same results were obtained by the navigation system; instead, 90.1% of femoral components were within the range of 3° varus/valgus based on the radiological measurement, whereas according to the navigation system, 86.4% were in this range. Conclusions The DASH iPOD TOUCH Navigation System is a precise and reliable instrument to assist in TKA navigation.

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Computer assistance in total knee replacement – a critical assessment of current health care technology

Cited by 8 publications

References 3 publications

Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component

Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component

Similar migration in computer-assisted and conventional total knee arthroplasty

Intraoperative validation of bone cut accuracy of a pinless smart touch‐screen navigation system device in total knee arthroplasty

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