Intra-operative tibial fracture during computer assisted total knee replacement: a case report

Abstract

Recently computer-assisted joint replacement surgery has been introduced to improve implant alignment. To date no intra-operative fractures have been reported related to the insertion of the navigation trackers used in this technique. The authors present the case of a 76-year-old man who sustained an intra-operative tibial fracture at the site of insertion of the navigation tracker during computer assisted total knee replacement.

Radiological and Functional Outcomes in Computer Assisted Total Knee Arthroplasty Between Consultants and Trainees — A Prospective Randomized Controlled Trial

“…The only significant difference was tourniquet time (P = b0.001). A slightly prolonged tourniquet time appears to be a consistent issue in other similar studies [1,9,26,29]. Prolonged surgical and tourniquet times are associated with increased infection rates and may compromise early post-operative quadriceps function [30][31][32].…”

One-Stage Long-Stem Total Knee Arthroplasty for Arthritic Knees with Stress Fractures

“…One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome. [1][2][3] and rheumatoid arthritis, 4,5 osteoarthritis, [6][7][8] osteoporosis, 1 post-traumatic deformity, 9 deformed degenerate knees, 4,10 Paget's disease, 11 pyrophosphate arthropathy, 12 and knee arthroplasty (unicondylar and navigated) [13][14][15][16] in elderly people. Stress fractures are usually treated by rest and/or casting 6,10,17 and rarely surgery.…”

Concepts in Computer Assisted Total Knee Replacement Surgery

“…The tibial slope showed a rate of inaccuracy of 3° or less for 98 % of the patients in the navigated TKA group versus 80% of the patients in the conventional group (Martin et al, 2007);  The possibility to do a three-dimensional planning and alignment of the prothesis (Stockl et al, 2004);  Dynamic assessment of deformity at any angle as opposed to conventional technique where tensioning devices can be used in 0° extension and 90° flexion (Aravind et al, 2011);  Assessment of soft tissue and collateral tension when gap balancing technique applied (Chauhan et al, 2004);  Intra-operative range of motion analysis to achieve maximum function, as confirmed by some reports like that of Austin et al, who observed as navigation could be a reliable tool for performing in vivo assessment of range of motion (Austin et al, 2008);  Decreased incidence of pulmonary embolism in knee surgery, due to using of only extra-medullary guidance (Kalairajah et al, 2005);  Minimally invasive surgery, which allows lesser blood loss during and after operation, reduces risks at transfusion and decreased hospital admission duration, those gives financial saving (Kalairajah et al, 2005);  Early rehabilitation and shorter hospital stay, due to improved accuracy in limb alignment and soft tissue balance obtained with computer-assisted TKA (Choong et al, 2009). Nevertheless, there are some disadvantages by using navigation:  The surgical time was longer for navigated TKA than for the conventional procedure (Martin et al, 2007);  Additional incisions for reference pins;  Increased incidence of fractures or infections related to the pins sites (less than 1% reported complication rate) (Wysocki et al, 2008;Chi-Huan et al, 2008;Manzotti et al, 2008;Bonutti et al, 2008;Jung et al, 2007;Ossendorf et al, 2006). According to literature, larger pins diameter (5 mm), eccentric or repeated drilling and diaphyseal placement may be at greater risk of such complication (Wysocki et al, 2008;Chi-Huan et al, 2008);  Financial saving by low hospital duration cost effective in health care however is still not realized.…”