Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

Tigani, Domenico; Masetti, Gilberto; Sabbioni, Giacomo; Ayad, R. Ben; Filanti, Mattia; Fosco, M.

doi:10.1007/s00264-011-1476-3

Cited by 45 publications

(45 citation statements)

References 25 publications

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“…17 To avoid a second operation, simultaneous corrective osteotomy and TKA was performed. Nonetheless, it is important to be alert for imbalanced soft tissue gap from the atypical bone cut of the intra-articular correction technique.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Rattanaprichavej

Laoruengthana

2016

J Orthop Surg (Hong Kong)

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This study reports 3 patients who underwent total knee arthroplasty combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia.Key words : arthroplasty, replacement, knee; fractures, ununited introduction It is difficult to obtain optimal mechanical alignment through total knee arthroplasty (TKA) in patients with knee deformity, because the deformity (canal sclerosis, crooked canal, or retained hardware) may prevent the use of an intramedullary guide. Distortion of an anatomic landmark secondary to a previous trauma or treatment can make TKA more challenging and the outcome less satisfactory.1,2 The deformity can be corrected using an intra-or extra-articular Total knee arthroplasty with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia: a report of three cases Piti Rattanaprichavej, Artit Laoruengthana Naresuan University, Thailand Address correspondence and reprint requests to: Piti Rattanaprichavej, Naresuan University, Thailand. Email: pt-rp@hotmail.com Surgery 2016;24(1):116-20 correction technique with a conventional instrument, computer-assisted navigation system, or patientspecific instrument. This study reports 3 patients who underwent TKA combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia. Journal of Orthopaedic case reportsA single surgeon performed all 3 TKAs under spinal anaesthesia with a femoral nerve block through the median parapatellar approach using conventional instruments and a fixed bearing, posterior-stabilised prosthesis. Preoperative planning was performed to determine the corrective osteotomy, cutting line so as not to endanger the collateral ligament attachment, amount of bone lost, and need for expanding stems or augments. Intra-operatively, prosthesis orientation, lower-limb alignment, and soft-tissue balance were checked using fluoroscopy. Postoperatively, standing radiograph of the knee was obtained at 1, 3, 6, and 12 months. Knee Society knee and function scores were assessed. The mean follow-up duration was 35 Vol. 24 No. 1, April 2016 TKA with extra-or intra-articular correction technique for deformity of the femur or tibia 117 (range, 29-39) months.

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Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Rattanaprichavej

Laoruengthana

2016

J Orthop Surg (Hong Kong)

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“…A number of studies [9][10][11][12][13] have suggested that there is improved alignment when this technology is used.…”

Section: Introductionmentioning

confidence: 99%

Are MRI-based, patient matched cutting jigs as accurate as the tibial guides?

Conteduca¹,

Iorio²,

Mazza³

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study is to evaluate the accuracy of VISIONAIRE (Smith & Nephew Inc., Memphis, TN, USA) Patient Matched cutting tibial jigs in comparison with extramedullary (EM) tibial instrumentation by analysing data as detected by intra-operative use of VectorVision knee navigation software from BrainLAB (Redwood City, CA, USA). Methods Twelve patients were selected for unilateral total knee replacement (TKR). They underwent a full-length weight-bearing anteroposterior (AP) radiograph and magnetic resonance imaging (MRI). During surgery, once the EM guides were placed and fixed on the tibia, the orientation in the coronal and sagittal planes was checked by the navigator and then compared with the data obtained by measuring the orientation of VISIONAIRE Patient Matched cutting tibial jigs. An unsatisfactory result was considered an error ≥2°in both coronal and sagittal planes for the tibial component as a possible error of 4°could result. Results In the coronal plane the mean deviation of the EM tibial guides from the ideal alignment (0°) was 0.7±0.39°a nd of the VISIONAIRE was 129±1.55°(P00.22). In the sagittal plane the mean deviation of the EM tibial guides from 3°of posterior slope was −1.62±1.78°and of the VISIONAIRE was +1.16±4.29°(P<0.05). Negative values indicate a more posterior slope from the ideal and positive values an anterior slope. Conclusions This preliminary study documented only a fair accuracy of the method with a consistent risk of error of more of 3°especially in the sagittal plane. We could speculate that the problem in the sagittal plane was due to the fact that the pre-operative protocol does not include a lateral X-ray projection of the knee and only includes an AP standing X-ray of the straight leg and MRI.

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“…It may be that computer navigation does have a role in complicated cases where there are angular deformities or retained metalware from other procedures [31].…”

Section: Discussionmentioning

confidence: 99%

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Allen

Hooper

Oram

et al. 2013

International Orthopaedics (SICOT)

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Purpose There remains controversy as to whether computernavigated total knee replacement (TKR) improves the overall prosthesis alignment and patient function. The aim of this study was to determine whether computer-assisted total knee arthroplasty provides superior prosthesis positioning when compared to a conventional jig-assisted total knee replacement and whether this affected the functional outcome. Methods This prospective, randomised controlled study compared computer navigated and conventional jig-assisted total knee replacement in 37 patients who underwent bilateral TKR. A quantitative assessment of the spatial positioning of the implant in the 74 total knee replacements was determined using a low-dose dual-beam CT scanning technique. This resulted in six parameters of alignment that were compared. Functional outcomes using the high activity arthroplasty score and Knee Society score were assessed pre-operatively, postoperatively, at three years and at five years. Patients also indicated which knee they felt was subjectively the best. Results There was no statistically significant difference in the prosthesis alignment between both groups and the number of outliers was not decreased with navigation. All function scores improved from pre-operative to postoperative but there was no statistically significant difference between the groups at five years. At five years, 40.6 % of patients thought their jigassisted knee was the better knee compared with 21.9 % their computer assisted knee and 37.5 % of patients who felt they were the same. Conclusion Computer-assisted implantation of total knee replacements does not offer a significant advantage in prosthesis alignment. There was no difference in functional outcome or subjective "best knee" between the computer-assisted or jig-assisted knee.

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Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

Cited by 45 publications

References 25 publications

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Are MRI-based, patient matched cutting jigs as accurate as the tibial guides?

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

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