Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty

Bäthis, H.; Perlick, L.; Tingart, Markus; Lüring, C.; Perlick, Carsten; Grifka, Joachim

doi:10.1007/s00264-003-0533-y

Cited by 102 publications

(49 citation statements)

References 18 publications

(27 reference statements)

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“…Although many studies have confirmed this theory [1,3,9,24,39], others have shown that there is no difference in orientation or alignment of the femoral or tibial components than that achieved by conventional methods [12,22,23,42]. When evaluating the published reports on navigation knee arthroplasty, two important factors limit comparisons among clinical series.…”

Section: Alignmentmentioning

confidence: 87%

“…However, the extent of malalignment below which good clinical results are expected is not known [21]. Many studies have shown that placement of components within ±3°of the mechanical axis reduces the risk of early loosening [1,5,11] whilst other studies have shown this threshold to be higher [14,21,41].…”

Section: Alignmentmentioning

confidence: 99%

“…It is well established that malalignment of either the tibial or femoral components is associated with loosening, instability and early implant failure [1]. However, the extent of malalignment below which good clinical results are expected is not known [21].…”

Section: Alignmentmentioning

confidence: 99%

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Navigation knee replacement

Dattani

Patnaik

Kantak

et al. 2008

International Orthopaedics (SICO

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Total knee replacement (TKR) achieves an immediate and exceptional restoration in the quality of life that is comparable only to a few other procedures. It has been suggested that the most common cause of revision TKR is error in surgical technique, from malpositioning of the components which results in a poorer post-operative outcome. Based on the theoretical assumption that the use of computer-assisted systems (CAS) in TKRs may improve implant alignment and thus implant longevity, the use of this technology is becoming increasingly popular. This article (a) reviews whether computer-assisted TKR (CASTKR) results in improved prosthesis alignment compared with the conventional technique, (b) assesses the functional and clinical outcomes of CASTKR and (c) evaluates the cost-effectiveness of using this technology.Résumé La prothèse totale du genou (TKR) permet de restaurer une qualité de vie comparable à peu d'autres techniques. Il est courant de penser que la cause la plus habituelle de reprise des prothèses du genou est secondaire à une erreur technique du fait d'un mauvais positionnement des composants. Sur le plan théorique, l'utilisation de la navigation (CAS) permet d'améliorer l'alignement des implants et donc la longévité de la prothèse. Cette technique devenant de plus en plus populaire. Cet article permet d'analyser les résultats en fonction de l'utilisation de la navigation comparée à une technique conventionnelle, avec évaluation clinique, fonctionnelle (CATKR) ainsi que le rapport coût/utilité de cette technique.

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Section: Alignmentmentioning

confidence: 87%

Section: Alignmentmentioning

confidence: 99%

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Navigation knee replacement

Dattani

Patnaik

Kantak

et al. 2008

International Orthopaedics (SICO

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“…Our objectives were: (1) to evaluate the strength of the association between standard pre-and postoperative radiographic and intraoperative navigation alignment measurements; (2) to determine the potential sources of error inherent to the process of radiographic and navigated alignment assessment; and (3) to examine the subtle differences that exist between desired alignment (anteroposterior [AP] mechanical axis and sagittal tibial and femoral axes of 0°) and clinically accepted alignment (final alignment after the bone cuts were made and implants placed) as assessed through an intraoperative navigation system.…”

Section: Introductionmentioning

confidence: 99%

Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate

Yaffe

Koo

Stulberg

2008

Clinical Orthopaedics &Amp; Related Research

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Precise pre-and postoperative anatomic measurements are necessary to plan, perform, and evaluate total knee arthroplasty (TKA). We evaluated the relationship between radiographic and navigation alignment measurements, identified sources of error in radiographic and navigated alignment assessment, and determined the differences between desired and clinically accepted alignment. Fifty-eight computer-assisted TKAs were performed and limb alignment measurements were recorded both pre-and postoperatively with standard radiographs and with an intraoperative navigation system. Intraoperative navigation produced consistent navigation-generated alignment results that were within 1°of the desired alignment. The difference between preoperative radiographic and navigation measurements varied by as much as 12°and the difference between postoperative radiographic and navigation measurements varied by as much as 8°. This discrepancy depended on the degree of limb deformity. Postoperative radiographic measurements have inherent limitations. Navigation can generate precise, accurate, and reproducible alignment measurements. This technology can function as an effective tool for assessing pre-and postoperative limb alignment and relating intraoperative alignment measurements to clinical and functional outcomes. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…These systems provide the opportunity to improve the accuracy of component orientation and restoration of the mechanical leg axis [3,12,17]. Using the computer-assisted technique, intraoperative angular and distance measurements have become available, with an accuracy of less than 1°or 1 mm [7].…”

Section: Introductionmentioning

confidence: 99%

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy

Bäthis

Perlick

Tingart

et al. 2004

International Orthopaedics (SICOT)

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Previous reports have described the potentially compromising effect of a high tibial osteotomy (HTO) on the results of a subsequent total knee arthroplasty (TKA). Although the reasons are not clear, some authors reported problems in soft-tissue balancing. In a prospective study, 22 patients with an average interval of 5.8 years after closed-wedge HTO were operated for TKA. All operations were performed with a CT-free navigation system, and measurements of the extension and flexion gap were assessed. The intraoperative data were compared to a control group of 100 consecutive computer-assisted TKA without previous osteotomy. In the study group, a highly significant shift towards a medial opening of the flexion gap between the posterior condylar line and the tibial resection (study group 0.4±4.7°medial opening versus control group 3.4±3.3°lateral opening, p<0.001) was observed. In the study group, 10/22 showed a medial opening of the flexion gap compared to 11/100 in the control group. Surgeons should be aware of difficulties in soft-tissue balance in TKA following HTO, especially for the flexion gap configuration and the axial rotation of the femoral component.Résumé Plusieurs rapports ont décrit l'effet potentiellement défavorable d'une ostéotomie tibiale supérieure sur les résultats d'une arthroplastie totale du genou secondaire. Bien que les raisons ne soient pas claires, quelques auteurs ont rapporté des problèmes dans l'équilibre des parties molles. Dans une étude prospective 22 malades ont eu une arthroplastie totale du genou avec un intervalle moyen de 5,8 ans après une ostéotomie tibiale. Toutes les opérations ont été exécutées avec un système de navigation sans scanner et l'intervalle en flexion et en extension a été mesuré. Les données intraopératoires ont été comparées à un groupe témoin de 100 arthroplasties totales du genou consécutives, sous contrôle informatique, sans ostéotomie préalable. Dans le groupe d'étude a été constaté une modification très importante vers une ouverture médiale de l'intervalle en flexion entre la ligne condylienne postérieure et la résection tibiale (groupe d'étude 0,4

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Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty

Cited by 102 publications

References 18 publications

Navigation knee replacement

Navigation knee replacement

Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy

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