Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?

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

doi:10.1007/s00167-007-0399-4

Cited by 99 publications

(89 citation statements)

References 33 publications

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“…Outlier rates were 5% to 21% for postoperative limb mechanical axis, 4% to 11% for femoral component alignment, and 3% to 11% for tibial component alignment. A higher outlier rate in some of these studies when compared to our results could be due to the fact that some of these studies involved multiple surgeons where individual experience with navigation could have played a role [8,10] (in contrast to our single-surgeon study), had relatively smaller number of knees (maximum of 100-500 TKAs) [2,8,10,11,14,17,26], and were performed early during the evolution of navigation software and tools (1999)(2000)(2001)(2002)(2003) [2,8,10,11] (Table 5).…”

Section: Discussioncontrasting

confidence: 56%

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Mullaji

Shetty

Lingaraju

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Computer navigation has improved accuracy and reduced the percentage of alignment outliers in TKA. However, the characteristics of outliers and the risk factors for limb malalignment after TKA are still unclear. Questions/Purposes We therefore addressed the following questions: (1) What is the incidence and characteristics of outliers for postoperative limb mechanical axis (hip-knee-ankle [HKA] angle outside the conventional 180°± 3°range) and component alignment in TKA? And (2) what are the preoperative clinical or radiographic risk factors for limb mechanical axis malalignment in TKA? Methods We retrospectively reviewed the clinical and radiographic records of 1500 computer-assisted TKAs to identify outliers for postoperative HKA axis and component alignment and determined risk factors for malalignment. Full-length hip-to-ankle and knee radiographs were used to measure preoperative HKA angle, femoral coronal bowing, joint divergence angle, tibial subluxation, and tibial bone loss and postoperative HKA angle and femoral and tibial component angle. Results The incidence of outliers for postoperative limb mechanical axis, femoral component alignment, and tibial component alignment was 7% (112 of 1500 TKAs), 7%, and 8%, respectively, with 70% of limbs placed in excessive varus and 30% in excessive valgus. Preoperative varus deformity of more than 20°and femoral bowing of more than 5°were associated with increased risk of placing the limb mechanical axis outside the acceptable ± 3°range after computer-assisted TKA. Conclusions The presence of preoperative radiographic risk factors should alert the surgeon to increased chance of malalignment and every measure should be undertaken in such at-risk knees to ensure proper limb and component alignment and soft tissue balance.

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Section: Discussioncontrasting

confidence: 56%

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Mullaji

Shetty

Lingaraju

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Long term, malalignment might increase the risk of loosening, instability, wear, and osteolysis [1-3, 6, 9, 18, 20, 24, 30-32]. After a decade of clinical use, computerassisted navigation has resulted in improved alignment but has not eliminated outliers and has not improved the clinical outcome [4,7,26,35]. One recent alternative has been the development of patient-specific instrumentation using MRI or CT imaging to generate patient-specific guides that can be used intraoperatively to control all six degrees of freedom of component alignment, which also controls limb and knee alignment.…”

Section: Introductionmentioning

confidence: 99%

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Nunley

Ellison

Zhu

et al. 2012

Clinical Orthopaedics &Amp; Related Research

207

175

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Background Coronal alignment may impact clinical outcome and survivorship in TKA. Patient-specific instrumentation has been developed to restore mechanical or kinematic axis and potentially reduce component malpositioning. Although it is clear these instruments add cost, it is unclear whether they improve alignment. Questions/purposes We determined whether the mean coronal alignment after TKA performed with conventional versus patient-specific instrumentation better restored the mechanical and kinematic axes and whether there were more outliers with one of the two methods. Methods We retrospectively evaluated 150 primary TKAs performed for osteoarthritis: Group 1 (n = 50) conventional instrumentation; Group 2 (n = 50) patientspecific instrumentation restoring the mechanical axis; Group 3 (n = 50) patient-specific instrumentation restoring the kinematic axis, and measured femorotibial angle, hipknee-ankle angle, and the zone of the mechanical axis from scout CT images taken 0 to 6 weeks postoperatively.

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“…10,11 In an evaluation of 3,152 TKAs, survival of 90% was observed when the mechanical axis was between 0 o and 4 o of varus or valgus, and of less than 73% when the mechanical axis was above 4 o of varus or valgus apud Ensini et al 4 . We believe that navigation serves to correct minor axis deviations axis that occur due to human error and can compromise the survival of the implant.…”

Section: Discussionmentioning

confidence: 99%

Navegação na artroplastia total do joelho: existe vantagem?

et al. 2011

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Objective: Aiming to evaluate whether navigation aided surgery? offers any advantages over the conventional technique, a randomized, prospective, comparative study was carried out, analyzing the placement of components, alignment of the limb, surgical time, blood loss and functional rehabilitation. Material and methods: We studied 39 patients submitted to 42 Total Knee Arthroplasties. In group 1 (n = 21) the surgery was navigated and in group 2 (n = 21) it was conventional. The patients were evaluated on panoramic radiographs of the lower limbs, CT scan and the Knee Society Score (KSS) preoperatively and three months postoperatively. Surgery time and postoperative blood loss were also evaluated. Results: Surgery time was longer in group 1.There was no significant difference in blood loss and the KSS. There was a greater proximity of the three degrees of external rotation and the five degrees of tilt in the coronal in group 2. The mechanical axis was closer to zero degree in group 1. Conclusions: Navigation promotes individualizing of the positioning of the components of the prosthesis, and offered advantages in limb realignment, compared with traditional methods. The surgerytime has a tendency to be higher in group 2, but this difference is not statistically significant. There were no differences between the groups in relation to blood loss and improvement in KSS. Level of Evidence: Level I, therapeutic studies.

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Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?

Cited by 99 publications

References 33 publications

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Navegação na artroplastia total do joelho: existe vantagem?

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