Computer-Assisted Navigation in Patellofemoral Arthroplasty: a New Technique to Improve Rotational Position of the Trochlea

Hernigou, Philippe; Flouzat-Lachaniette, Charles-Henri; Delblond, William; Duffiet, Pascal; Julian, Didier

doi:10.1007/s11420-013-9328-x

Cited by 16 publications

(12 citation statements)

References 12 publications

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“…24,25 Prior literature also suggests that computer navigation improves trochlear rotation in PFA, and smaller studies of robotic-arm-assisted BKA have shown good results. 18,23 In this study, we did not find that improved revision rates after CA partial knee arthroplasty persisted at the 2-year time point.…”

Section: Discussioncontrasting

confidence: 62%

“…19,20 The most consistently described benefit of computer assistance in knee arthroplasty is improved implant position and accurate alignment. [21][22][23] For UKA specifically, low-volume surgeons have higher revision rates, and robotics reduce revision and improve alignment in the hands of these surgeons. 24,25 Prior literature also suggests that computer navigation improves trochlear rotation in PFA, and smaller studies of robotic-arm-assisted BKA have shown good results.…”

Section: Discussionmentioning

confidence: 99%

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Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non–computer-assisted Arthroplasty

Malyavko

Cohen

Fuller

et al. 2022

J Am Acad Orthop Surg

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Background:Computer assistance can help surgeons achieve mechanical accurate alignment, but the clinical effect of this technology in different arthroplasty types remains controversial because of conflicting functional outcomes, revision rates, and complication rates. The goal of this study was to compare 90-day medical complications and 1 and 2-year revision surgeries after computer-assisted patellofemoral arthroplasty, unicompartmental knee arthroplasty (CA-UKA), bicompartmental knee arthroplasty (CA-BKA), and total knee arthroplasty (CA-TKA) with non-computer-assisted procedures.Methods:A retrospective cohort analysis was conducted using the Mariner data set of the PearlDiver Patient Records Database from 2010 to 2018. Current Procedural Terminology codes were used to identify patients who underwent patellofemoral arthroplasty, unicompartmental knee arthroplasty, bicompartmental knee arthroplasty, and total knee arthroplasty with or without computer assistance for osteoarthritis. All included patients were followed up for 2 years. Univariate and multivariable analyses were conducted.Results:On multivariable analysis, revision within 1 year was decreased in patients who underwent computer-assisted patellofemoral arthroplasty (odds ratio [OR]: 0.541, P = 0.031), CA-UKA (OR: 0.798, P = 0.019), and computer-assisted bicompartmental knee arthroplasty (OR: 0.186, P = 0.025) compared with the same surgeries without technology assistance. CA-TKA had decreased odds of revision for aseptic loosening at 2 years (OR: 0.789, P < 0.001). CA-UKA and CA-TKA had decreased risk of overall 90-day medical complications (OR: 0.838, P < 0.001; OR: 0.903, P < 0.001, respectively) and major complications (OR: 0.750, P = 0.004; OR: 0.822, P < 0.001, respectively).Discussion:Complication rates and revision surgeries for all arthroplasty types were equivalent or more favorable when computer assistance was used during surgery. Our results quantify some early benefits to using computer assistance in total and partial knee arthroplasties.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non–computer-assisted Arthroplasty

Malyavko

Cohen

Fuller

et al. 2022

J Am Acad Orthop Surg

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“…65 showed that navigation was a safe and reliable method to obtain correct implant correction with the Avon implant. Hernigou et al replicated these findings, showing no maltracking in the navigated group in their study 66 .…”

Section: Surgical Techniquementioning

confidence: 69%

Modern Patellofemoral Arthroplasty

Bond,

Stauffer,

Hendren

et al. 2023

JBJS Reviews

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Introduction: The ideal procedure for isolated patellofemoral arthritis is a controversial topic. Patellofemoral arthroplasty (PFA) is an option that aims to restore normal kinematics to the knee while preserving bone. PFA has been shown to have benefits compared with total knee arthroplasty (TKA) in this patient population but has historically had a high failure rate. Revision rates are improving with modern implants and tight indications but still remain higher than TKA. This review summarizes current thinking around PFA using modern implants and techniques in 2023, provides an implant-specific analysis, and assesses how we can improve outcomes after PFA based on the current literature. The aim was to provide an outline of the evidence around PFA on which surgeons can make decisions to optimize patient outcome in this young and active population. Methods: Four databases (MEDLINE, Embase, Scopus, and SPORTDiscus) were searched for concepts of patellofemoral joint arthroplasty. After abstract and text review, a screening software was used to assess articles based on inclusion criteria for studies describing indications, outcomes, and techniques for isolated PFA using modern implants, with or without concomitant procedures. Results: A total of 191 articles were included for further examination, with 62 articles being instructional course lectures, systematic reviews, technique articles, narrative reviews, expert opinions, or meta-analyses. The remaining articles were case reports, trials, or cohort studies. Articles were used to create a thorough outline of multiple recurrent topics in the literature. Conclusions: PFA is an appealing option that has the potential to provide a more natural feeling and functioning knee for those with isolated PF arthritis. The high rate of revision is a cause for concern and there are several technical details that should be stressed to optimize results. The uncertain outcome after revision to TKA also requires more investigation. In addition, the importance of strict selection criteria and firm indications cannot be stressed enough to optimize longevity and attempt to predict those who are likely to have progression of tibiofemoral osteoarthritis. The development of new third-generation implants is promising with excellent functional outcomes and a much lower rate of maltracking and implant complications compared with earlier generations. The impact of these implants and improvement in surgical techniques on the revision rate of PFA will be determined from longer-term outcomes.

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“…Current designs use more sophisticated guiding instruments that mostly refer to the intramedullary femoral canal, anterior cortex, mechanical tibial axis, femoral epicondyles, direction of the native trochlea or a combination of these. Some authors remind us of the added value of navigation [10]. Most PFAs are based on TKA trochlea templates and anterior femoral cuts (Bonlay^) or sinking the trochlea shield into the native trochlea (Binlay^).…”

Section: Discussionmentioning

confidence: 99%

A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years

Hoogervorst

Jong²,

Hannink

et al. 2015

International Orthopaedics (SICOT)

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A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years (range, 110-200). Median VAS Pain was 30 (range, 0-80) and VAS Satisfaction median was 90 (range, 50-100). Thirteen (62 %) PFAs were rated excellent, six (28 %) as good and two (10 %) as fair. Twelve (36 %) of the cases required further surgery within 4 years after implantation. Seven of these (21 %) were converted to TKA after a mean time of 5.5 years, five out of seven were converted because of ongoing tibiofemoral osteoarthritis (TFOA).Conclusions We found a rate of 21 % (7/33) conversion of the Richards' II PFA to TKA after a mean of 5.5 years; 71 % (5/7) of cases were because of TFOA. We strongly advise not to use PFA if there is any sign of joint disease in other compartments than patellofemoral.

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Computer-Assisted Navigation in Patellofemoral Arthroplasty: a New Technique to Improve Rotational Position of the Trochlea

Abstract: The short-term results suggest that navigation can lead to better trochlear rotation which, in our hands, is associated with fewer cases of patellar maltracking and better overall clinical scores.

Cited by 16 publications

References 12 publications

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non–computer-assisted Arthroplasty

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non–computer-assisted Arthroplasty

Modern Patellofemoral Arthroplasty

A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years

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