Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Yau, WP; Chiu, K. Y.; Zuo, Jianlin; Tang, W.M.; Ng, T P

doi:10.1007/s11999-008-0144-4

Cited by 56 publications

(47 citation statements)

References 25 publications

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“…The reported inter-and intraobserver agreement in these measurements was strong to perfect [21]. Two of the authors (WPY, CHY) assessed the axial alignment of the lower limb and joint line obliquity in the digitalized standing radiographs of the whole lower limb.…”

Section: Methodsmentioning

confidence: 99%

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

Yau

Chiu

Fok

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The lower limb osteometry of Chinese differs from that of whites. The joint line of the knee in the coronal plane in Chinese is more medially inclined and the posterior condylar angle of the distal femur in the axial plane is larger. However, it is unclear whether there is any direct association between the coronal plane and axial plane osteometry. Questions/purposes We asked whether the joint line obliquity of the knee is related to the posterior condylar angle of the distal femur in young Chinese subjects. Methods Ninety-nine young Chinese patients with anterior cruciate ligament injuries were recruited. The lower limb alignment and joint line obliquity were measured using standing long radiographs of the whole lower limb.The rotational alignment of the distal femur was assessed in the axial cuts of the MRI. Results The distal femur rotational alignment was associated with the obliquity of the knee in Chinese. The posterior condylar angle was 5°± 2°. The knee was 5°± 3°medially inclined. Conclusions The joint line of the knee in a group of young Chinese patients was more medially inclined than that of whites. The posterior condylar angle of the distal femur was larger. The presence of an association between distal femur rotational alignment and joint line obliquity in this group of young Chinese patients suggests a possible developmental cause explaining the difference in osteometry between races.

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Section: Methodsmentioning

confidence: 99%

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

Yau

Chiu

Fok

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…They reported patients who underwent navigated TKA had a lower risk of limb and implant malalignment at more than 3°with respect to the mechanical axis and an outlier rate of 12% to 13% for the limb mechanical axis. Despite the accuracy, individual studies have reported an outlier rate of 0% to 29% with navigated TKA for limb mechanical axis [16,17,24,28,29]. This wide variation may be due to the small number of navigated knees (ranging from 32 to 282) included in most of these studies and the fact that most of these cases were part of an early series where surgeon experience might have played a role in the alignment outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, none of these studies have analyzed the causes or risk factors for malalignment. Few [17,24,28] have attributed malalignment to reasons such as error during bone cuts, error during registration, displacement of the infrared arrays during the procedure, and errors that occur during obtaining and measuring postoperative radiographs.…”

Section: Introductionmentioning

confidence: 99%

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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“…It has been suggested that computer navigation could be used as a teaching tool and result in superior results even for the occasional TKR surgeon [1,4,8]. In 2008, Yau et al, in a retrospective study, failed to show any improvement in postoperative alignment using a computer-assisted technique in a low volume knee practice [25]. In 2005, Daubresse et al hypothesised that the learning curve for a computer navigated TKR technique can not be any longer than that of the free-hand technique, even in a community hospital [6].…”

Section: Introductionmentioning

confidence: 99%

Relationship between cutting errors and learning curve in computer-assisted total knee replacement

Manzotti

Cerveri

Momi

et al. 2009

International Orthopaedics (SICOT)

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Computer-assisted total knee replacement (TKR) has been shown to improve radiographic alignment. Continuous feedback from the navigation system allows accurate adjustment of the bone cuts, thus reducing errors. The aim of this study was to determine the impact of experience both with computer navigation and knee replacement surgery on the frequency of errors in intraoperative bone cuts and implant alignment. Three homogeneous patient groups undergoing computer assisted TKR were included in the study. Each group was treated by one of three surgeons with varying experience in computer-aided and knee replacement surgery. Surgeon A had extensive experience in knee replacement and computer-assisted surgery. Surgeon B was an experienced knee replacement surgeon. A general orthopaedic surgeon with limited knee replacement surgery experience performed all surgeries in group C. The cutting errors and the number of re-cuts were determined intraoperatively. The complications and mean surgical time were collected for each group. The postoperative frontal femoral component angle, frontal tibial component angle, hip-knee-ankle angle and component slopes were evaluated. The results showed that the number of cutting errors were lowest for TKR performed by the surgeon with experience in navigation. This difference was statistically significant when compared to the general orthopaedic surgeon. A statistically significant superior result was achieved in final mechanical axis alignment for the surgeon experienced in computerguided surgery compared to the other two groups (179.3°c ompared to 178.9°and 178.1°). However, the total number of outliers was similar, with no statistically significant differences among the three surgeons. Experience with navigation significantly reduced the surgical time.

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Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Cited by 56 publications

References 25 publications

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

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

Relationship between cutting errors and learning curve in computer-assisted total knee replacement

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