Relationship between cutting errors and learning curve in computer-assisted total knee replacement

Abstract

Computer-assisted total knee replacement (TKR) has been shown to improve radiographic alignment. Continuous feedback from the navigation system allows accurate adjustment of the bone cuts, thus reducing errors. The aim of this study was to determine the impact of experience both with computer navigation and knee replacement surgery on the frequency of errors in intraoperative bone cuts and implant alignment. Three homogeneous patient groups undergoing computer assisted TKR were included in the study. Each group was treated by one of three surgeons with varying experience in computer-aided and knee replacement surgery. Surgeon A had extensive experience in knee replacement and computer-assisted surgery. Surgeon B was an experienced knee replacement surgeon. A general orthopaedic surgeon with limited knee replacement surgery experience performed all surgeries in group C. The cutting errors and the number of re-cuts were determined intraoperatively. The complications and mean surgical time were collected for each group. The postoperative frontal femoral component angle, frontal tibial component angle, hip-knee-ankle angle and component slopes were evaluated. The results showed that the number of cutting errors were lowest for TKR performed by the surgeon with experience in navigation. This difference was statistically significant when compared to the general orthopaedic surgeon. A statistically significant superior result was achieved in final mechanical axis alignment for the surgeon experienced in computerguided surgery compared to the other two groups (179.3°c ompared to 178.9°and 178.1°). However, the total number of outliers was similar, with no statistically significant differences among the three surgeons. Experience with navigation significantly reduced the surgical time.

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

“…[1,[21][22][23][24][25][26][27] Post-operative alignment was comparable between the two groups (P = 0.15), as were blood loss and length of incision (P = 0.45 and 0.78 respectively). Using CAS the trainees group were able to perform a similar TKA operation to the consultant group.…”

The effect of pelvic movement on the accuracy of hip centre location acquired using an imageless navigation system

“…Numerous authors have studied the accuracy of CAS in knee arthroplasty, with very large series of patients [8][9][10][11][12], but to our knowledge, only one publication focuses on the influence of pelvic movement during acquisition of the hip centre [13]. Nevertheless this point is fundamental to the procedure, and a mistake in acquisition may lead to an error in the final positioning of the implant.…”

Navegação na artroplastia total do joelho

“…Although there are many studies in the literature with good levels of evidence proving that navigation-assisted surgery has greater precision for obtaining the desired alignment for the lower limb (8,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) , it is still not possible to demonstrate gains in the clinical results or in the longevity of implants, despite some favorable studies (12,14,25,26,(32)(33)(34)(35)(36)(37)(38)(39)(40) . Although there is some controversy, there is evidenced of possible parallel benefits relating to a lower thromboembolism rate (41)(42)(43) and a lower level of bleeding (11,(44)(45)(46)(47) with navigation.…”