Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?

Cheng, Tao; Zhao, Song; Peng, Xiaochun; Zhang, Xianlong

doi:10.1007/s00167-011-1588-8

Cited by 221 publications

(191 citation statements)

References 108 publications

(154 reference statements)

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“…With 30.43 % of knees within the ± 3°range in the conventional group, our results are just in line with the average rate of outliers obtained in the HKA angle by other authors [11,12]. In our opinion, this confirms that the study followed a correct procedure and adds credibility to our findings.…”

Section: Discussionsupporting

confidence: 92%

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Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare radiological results of total knee arthroplasties (TKAs) performed with patient-specific computed tomography (CT)-based instrumentation and conventional technique. The main study hypothesis was that CT-based patient-specific instrumentation (PSI) increases the accuracy of TKA. Methods A prospective, randomized controlled trial was carried out between January and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients operated on with the aid of the Signature™ CT-based implant positioning system. The control group consisted of 60 patients operated on using conventional instrumentation. The radiographic evaluation of implant positioning and overall coronal alignment was performed 12 months after the surgery by using standing anteroposterior radiographs of the entire lower limb and standard lateral radiographs. Results Of the 112 patients initially enrolled for the study, 95 were included in the subsequent analyses. There were no statistically significant differences between groups in respect to coronal and sagittal component positioning and overall coronal alignment, except for frontal tibial component positioning. For this parameter, better results were obtained in the control group, with borderline statistical significance. Conclusions Our study did not reveal superiority of the CTbased PSI system over conventional instrumentation. Further high-quality investigations of patient-specific systems are absolutely indispensable to assess their utility for TKA. In our opinion, the surgeon applying PSI technology is required to have advanced knowledge and considerable experience with the conventional method.

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Section: Discussionsupporting

confidence: 92%

“…It has been demonstrated that a varus or valgus malalignment of the mechanical axis of the operated limb > 3°is associated with up to 20 % higher incidence of implant loosening [9,10]. With currently available conventional instrumentation, malalignment > 3°is seen in ∼30 % of primary knee arthroplasty procedures [11,12].…”

Section: Introductionmentioning

confidence: 99%

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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“…Computer navigation has facilitated more accurate component placement and limb alignment restoration after TKA [5,7,9]. In three recent meta-analyses of randomized controlled trials comparing navigated versus conventional TKAs [5,7,9], 1119 to 2268 navigated TKAs from 21 to 41 trials were analyzed.…”

Section: Introductionmentioning

confidence: 99%

“…In three recent meta-analyses of randomized controlled trials comparing navigated versus conventional TKAs [5,7,9], 1119 to 2268 navigated TKAs from 21 to 41 trials were analyzed. 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.…”

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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“…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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Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?

Abstract: Therapeutic study (Systematic review of Level I/II studies), Level II.

Cited by 221 publications

References 108 publications

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

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

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

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