Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect coronal alignment

Carli, Alberto; Aoude, Ahmed; Reuven, Avishai; Matache, Bogdan A.; Antoniou, John; Zukor, David J.

doi:10.1503/cjs.031313

Cited by 12 publications

(6 citation statements)

References 45 publications

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“…The current study used a single infrared-based imageless navigation system to measure coronal mechanical alignment. Although reliable and reproducible, alignment measurements can vary between imageless and computed tomography-based navigation systems 12) and hence the findings of the current study need to be validated using different navigation systems. To the best of our knowledge, this is the first study in the literature which has analysed the effect of sagittal knee deformity on coronal mechanical alignment measurements using preoperative radiographs and navigation during TKA.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Shetty

Mullaji

Khalifa

et al. 2017

Knee Surg Relat Res

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PurposeThe purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity).Materials and MethodsCoronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs.ResultsThe mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques.ConclusionsThe mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.

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Section: Discussionmentioning

confidence: 99%

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Shetty

Mullaji

Khalifa

et al. 2017

Knee Surg Relat Res

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“…In a study performed by Carli et al [ 31 ] comparing two different computer navigation systems, the results showed a significant difference. However, in both study groups there were rather high numbers of outliers, 24 and 32%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?

Rahm

Camenzind

Hingsammer

et al. 2017

BMC Musculoskelet Disord

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BackgroundThere have been conflicting studies published regarding the ability of various total knee arthroplasty (TKA) techniques to correct preoperative deformity. The purpose of this study was to compare the postoperative radiographic alignment in patients with severe preoperative coronal deformity (≥10° varus/valgus) who underwent three different TKA techniques; manual instrumentation (MAN), computer navigated instrumentation (NAV) and patient specific instrumentation (PSI).MethodsPatients, who received a TKA with a preoperative coronal deformity of ≥10° with available radiographs were included in this retrospective study. The groups were: MAN; n = 54, NAV; n = 52 and PSI; n = 53. The mechanical axis (varus / valgus) and the posterior tibial slope were measured and analysed using standing long leg- and lateral radiographs.ResultsThe overall mean postoperative varus / valgus deformity was 2.8° (range, 0 to 9.9; SD 2.3) and 2.5° (range, 0 to 14.7; SD 2.3), respectively. The overall outliers (>3°) represented 30.2% (48 /159) of cases and were distributed as followed: MAN group: 31.5%, NAV group: 34.6%, PSI group: 24.4%. No significant statistical differences were found between these groups. The distribution of the severe outliers (>5°) was 14.8% in the MAN group, 23% in the NAV group and 5.6% in the PSI group. The PSI group had significantly (p = 0.0108) fewer severe outliers compared to the NAV group while all other pairs were not statistically significant.ConclusionsIn severe varus / valgus deformity the three surgical techniques demonstrated similar postoperative radiographic alignment. However, in reducing severe outliers (> 5°) and in achieving the planned posterior tibial slope the PSI technique for TKA may be superior to computer navigation and the conventional technique. Further prospective studies are needed to determine which technique is the best regarding reducing outliers in patients with severe preoperative coronal deformity.

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“…Comparing computer navigation systems in orthopedics is not uncommon; yet, most are not related to spine surgeries. 12 , 13 Honl et al compared acetabular cup orientation between five different computer-assisted navigation systems for total hip arthroplasty and demonstrated significant differences among them. 12 In addition, Carli et al compared the accuracy of intraoperative measurements to postoperative tibial and femoral alignment in two different computer-assisted systems for total knee arthroplasty and found a significant difference in the outcome as well.…”

Section: Discussionmentioning

confidence: 99%

“… 12 In addition, Carli et al compared the accuracy of intraoperative measurements to postoperative tibial and femoral alignment in two different computer-assisted systems for total knee arthroplasty and found a significant difference in the outcome as well. 13 Interestingly, several clinical studies have demonstrated high accuracy rates of pedicle screw placement using CT-based navigation compared with other methods, such as freehand technique and fluoroscopic navigation. 14 , 15 However, a critical aspect of the operative procedure was not taken into account, which is the type of computer navigation system being used.…”

Section: Discussionmentioning

confidence: 99%

Differences between Manufacturers of Computed Tomography–Based Computer-Assisted Surgery Systems Do Exist

Nooh

Lubov

Aoude

et al. 2017

Global Spine Journal

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Study DesignLiterature review.ObjectiveSeveral studies have shown that the accuracy of pedicle screw placement significantly improves with use of computed tomography (CT)-based navigation systems. Yet, there has been no systematic review directly comparing accuracy of pedicle screw placement between different CT-based navigation systems. The objective of this study is to review the results presented in the literature and compare CT-based navigation systems relative only to screw placement accuracy.MethodsData sources included CENTRAL, Medline, PubMed, and Embase databases. Studies included were randomized clinical trials, case series, and case–control trials reporting the accuracy of pedicle screws placement using CT-based navigation. Two independent reviewers extracted the data from the selected studies that met our inclusion criteria. Publications were grouped based on the CT-based navigation system used for pedicle screw placement.ResultsOf the 997 articles we screened, only 26 met all of our inclusion criteria and were included in the final analysis, which showed a significant statistical difference (p < 0.0001, 95% confidence interval 0.92 to 1.23) in accuracy of pedicle screw placement between three different CT-based navigation systems. The mean (weighted) accuracy of pedicle screws placement based on the CT-based navigation system was found to be 97.20 ± 2.1% in StealthStation (Medtronic, United States) and 96.1 ± 3.9% in VectorVision (BrainLab, Germany).ConclusionThis review summarizes results presented in the literature and compares screw placement accuracy using different CT-based navigation systems. Although certain factors such as the extent of the procedure and the experience and skills of the surgeon were not accounted for, the differences in accuracy demonstrated should be considered by spine surgeons and should be validated for effects on patients’ outcome.

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Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect coronal alignment

Cited by 12 publications

References 45 publications

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?

Differences between Manufacturers of Computed Tomography–Based Computer-Assisted Surgery Systems Do Exist

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