No difference in accuracy between pinless and conventional computer-assisted surgery in total knee arthroplasty

Baier, Christel; Maderbacher, Günther; Springorum, Hans-Robert; Zeman, Florian; Fitz, Wolfgang; Schaumburger, Jens; Grifka, Joachim; Beckmann, Johannes

doi:10.1007/s00167-013-2430-2

Cited by 23 publications

(31 citation statements)

References 20 publications

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“…Navigation solely of the tibial cut would therefore be sufficient to securely restore leg axis, with concomitant enormous saving in additional time needed for navigation. Furthermore, this partial navigation technique can also be performed using a reduced, pinless, navigational workflow with high accuracy, which further reduces complications of pin placement [2]. There are several limitations of our study.…”

Section: Discussionmentioning

confidence: 99%

“…We tested the hypotheses that: (1) the modified surgical technique with reduced navigation workflow approaches natural knee kinematics with lateral femoral rollback and tibial internal rotation with flexion; (2) alter condylar liftoff without midflexion instability; (3) significantly differ in femoral and tibial cuts, (4) restore the limb axis, and (5) there would be no differences in clinical outcome measures [Knee Society Scores (KSS), Western Ontario and McMaster Osteoarthritis Index (WOMAC)] prior to and at the latest follow-up between groups.…”

Section: Introductionmentioning

confidence: 99%

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Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Baier

Fitz

Craiovan

et al. 2013

International Orthopaedics (SICOT)

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Purpose Navigation-based total knee arthroplasty (TKA) has proven its value for restoration of the limb axis. However, patient-orientated results after TKA show a wide variation from the correct implantation technique. Nonphysiological kinematics without posterior femoral rollback and tibial internal rotation in flexion could be one reason for this. We postulated that a modified gap-balancing technique with navigation of the tibia alone, in comparison to a conventional navigated technique, would: (1) obtain lateral femoral rollback, (2) alter condylar liftoff without midflexion instability, (3) significantly differ in femoral and tibial cuts, (4) not be inferior in leg-axis restoration and (5) be comparable in clinical short-term scores. Methods In this prospective study, we compared in vivo navigation-based kinematics pre-and postoperatively of 40 consecutive TKA comprising 21 conventional navigationbased TKA and 19 TKA with the modified gap-balancing technique and a reduced navigation workflow. All cuts were double checked and compared with cuts proposed by the navigation system. Clinical results were assessed preoperatively and six months postoperatively. Results The modified gap-balancing technique resulted in significantly increased lateral femoral rollback (mean 16.3 mm) and lateral condylar liftoff (mean 1.3 mm) compared to the conventional group. The modified technique comprised an average of 2.1 mm less distal femoral resection and an average of 4°less external rotation and 3.5°more flexion of the femoral component compared with the control group. Average tibial resection height was 1.1 mm greater and average tibial slope was 0.5°elevated compared to the control group. A neutral leg axis was achieved in all cases. Results showed no significant differences in clinical scores between groups. Conclusion A partial navigation solely of the tibial cut can securely restore the leg axis. Modification of the surgical technique can possibly reproduce more physiological knee kinematics with higher lateral femoral rollback in flexion without midflexion instability. This might help reduce postoperative problems with the new implant and thus reduce the amount of unsatisfactory results. Despite equal short-term results, mid-to long-term results are needed to prove whether or not this correlates with better clinical results and at least equal implant longevity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Baier

Fitz

Craiovan

et al. 2013

International Orthopaedics (SICOT)

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“…12 In addition, Chen et al have found that pinless navigation is an effective tool for reducing the proportion of outliers of normal alignment. 13 However, whether the satisfactory alignment or decreased proportion of outliers translated to any detectable differences in clinical outcomes was not previously described.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of computer-assisted total knee arthroplasty using pinless navigation

Jiang

Chen

Chong

et al. 2017

J Orthop Surg (Hong Kong)

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This study aims to evaluate the 2-year post-operative clinical outcomes of patients undergoing total knee arthroplasty (TKA) with computer-assisted surgery (CAS) using the pinless BrainLAB ® VectorVision ® Knee 2.5 Navigation System versus standard CAS. A retrospective case-control study of 200 patients who underwent TKA with CAS from 2008 to 2012 was conducted. Patients in the pinless arm underwent a shorter duration of surgery compared to the standard CAS arm with 72 + 13 min and 83 + 11 min, respectively (p < 0.001), with improvement in Oxford Knee Score from 34 + 8 to 18 + 5 and 34 + 9 to 18 + 5, respectively, without statistically significant differences in clinical outcomes at 2 years.

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“…HKA hip-knee-ankle angle, mLDFA mechanical lateral distal femoral angle, mLPFA mechanical lateral proximal femoral angle, MediCAD_ AMA angle between the anatomical and the mechanical femoral axis determined with computer software, surgeon_AMA angle between the anatomical and the mechanical femoral axis determined by the surgeon by means of manual planning [1,14]. Because of the reported large anatomical differences in the AMA between 2° and 12.5° [7,21], we expected that preoperative measurement of the AMA would result in optimal coronal alignment perpendicular to the mechanical femoral axis [3,16,21].…”

Section: Discussionmentioning

confidence: 99%

What is the optimal valgus pre-set for intramedullary femoral alignment rods in total knee arthroplasty?

Maderbacher¹,

Keshmiri²,

Schaumburger³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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No difference in accuracy between pinless and conventional computer-assisted surgery in total knee arthroplasty

Abstract: In clinical routine, pinless CAS can comprise the advantages of CAS leaving the disadvantages aside. It reduces surgical time and avoids complications associated with the tracking pins of conventional CAS.

Cited by 23 publications

References 20 publications

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Clinical outcomes of computer-assisted total knee arthroplasty using pinless navigation

What is the optimal valgus pre-set for intramedullary femoral alignment rods in total knee arthroplasty?

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