Computer Navigation in Primary Total Knee Arthroplasty (original) (raw)
Related papers
Computerised and technical navigation in total knee-arthroplasty
Journal of Orthopaedics and Traumatology, 2005
The objective of the study was to evaluate the precision, concordance, practicability and the early clinical outcome of the use of a computerised navigation system in a comparative study with a group of 100 patients. Two groups of 50 patients each underwent implantation of a bicondylar knee prosthesis either by means of the freehand navigation system or by means of technical instrumentation. We found that the computerised navigation system provided a higher precision than the technically instrumented implantation: 94% of the prostheses implanted with the navigation system have an alignment within a range of -3° to 3° on of the Mikulicz line. Only 46% of the patients operated by means of the technical instrumentation reached this aspired result. Furthermore, the navigation system showed smaller ranges in the deviation of the aspired alignment. The radiological and computer-modeled alignment values differed both pre- and postoperatively, but to a larger extent before surgery. The varus or valgus deviations of the axis were more distinct radiologically under the weight of the patient’s body than in the computer model. The clinical outcome examined by the use of the HSS score after a mean followup of 7 months is good in both groups, and without significant differences. On average, the duration of surgery was 13 minutes longer in the computerised navigation group. We conclude that the benefit of the computerised navigation system is represented by the high improvement of precision. Achieving early clinical results identical to those in the technical instrumentation group, we expect a reduction of aseptic loosening in the computerised navigation group.
Computer navigation and total knee arthroplasty
Orthopedics, 2014
Research has added evidence in favor of computer-navigated techniques over conventional surgery for total knee arthroplasty (TKA). The goal of the current meta-analysis was to compare the outcome of outliers in mechanical axis and postoperative complications in patients undergoing conventional vs computer-navigated techniques for TKA. English literature searches were performed in PubMed, EMBASE, Web of Science, and the Cochrane Library for studies published between January 2002 and August 2012. Randomized, controlled trials comparing computer navigation with conventional surgery for the measurement of mechanical axes in patients with primary osteoarthritis were considered eligible. Fifteen trials were eligible for inclusion. The baseline demographics of 2089 patients (computer-navigated=1111; conventional=978) were well matched. Publication bias was eliminated using the funnel plot. A mechanical axis of more than 30° was considered to be malalignment and an outlier in limb alignment...
BMC Musculoskeletal Disorders, 2013
Background: There are few Scandinavian studies on the effect of computer assisted orthopedic surgery (CAOS) in total knee arthroplasty (TKA), compared to conventional technique (CON), and there is little information on effects in pain and function scores. This retrospective study has evaluated the effects of CAOS on radiological parameters and pain, function and quality of life after primary TKA. Methods: 198 primary TKAs were operated by one surgeon in two district hospitals; 103 CAOS and 95 CON. The groups were evaluated based on 3 months post-operative radiographs and a questionnaire containing the knee osteoarthritis outcome score (KOOS), the EQ-5D index score and a visual analogue scale (VAS) two years after surgery. Multiple linear regression method was used to investigate possible impact from exposure (CON or CAOS). Results: On hip-knee-ankle radiographs, 20% of measurements were > ±3°of neutral in the CAOS group and 25% in the CON group (p = 0.37). For the femoral component, the number was 5% for CAOS and 18% for CON (p < 0.01). For the tibial component, the difference was not statistically significant (p = 0.58). In the sagittal plane, the surgeon tended to apply more femoral flexion and more posterior tibial slope with CAOS. We observed no statistically or clinically significant difference in KOOS score, VAS or ΔEQ-5D (all p values >0.05), but there was a trend towards better scores for CAOS. Operation time was 3 minutes longer for CON (p = 0.37). Conclusions: CAOS can improve radiological measurements in primary TKA, and makes it possible to adjust component placement to the patient's anatomy. Overall , the two methods are equal in pain, function and quality-of-life scores.
Applying computer-assisted navigation techniques to total hip and knee arthroplasty
American journal of orthopedics (Belle Mead, N.J.)
Appropriate implant alignment is a major goal of total joint arthroplasty. Obtaining appropriate alignment typically involves making intraoperative decisions in response to visual and tactile feedback. Integrated computer-based systems provide the option of continuous real-time feedback and offer the potential to decrease intraoperative errors while enhancing the surgical learning experience. Computer-assisted orthopedic surgery helps the surgeon perform both intraoperative and postoperative technical audits of implant alignment. Improving implant alignment can be correlated with improved long-term clinical outcomes. However, despite emerging data, many surgeons remain wary of computer-assisted orthopedic surgery.
Computer-Assisted Navigation Software Advancements Improve the Accuracy of Total Knee Arthroplasty
The Journal of Arthroplasty, 2011
The purpose of this study was to evaluate the effectiveness of software advancements in improving total knee component positioning and limb alignment when using computer-aided navigation. A single total joint fellowship-trained surgeon performed unilateral total knee arthroplasty on 315 patients using conventional techniques or with assistance from computer navigation software. Preoperative and postoperative x-ray measurements were taken and analyzed. Our previous work demonstrated a statistically significant improvement (P b .02) in limb alignment (±3°of biomechanical neutral) when using version 2.0 software (93%) when compared with conventional techniques (82%). Further improvement was demonstrated with the version 3.1 software (99%, P b .03). The tourniquet times were recorded for each group and showed a significant improvement with the 3.1 software (conventional = 74 minutes, 2.0 navigation = 90 minutes, and 3.1 navigation = 73 minutes). The Stryker 2.0 software (Stryker Orthopedics, Mahwah, NJ) tourniquet time was statistically significantly longer than either the conventional or the 3.1 group (P b .001). Outcomes-based studies will be required to see if these factors will lead to improved patient function and/or prolonged prosthetic survival rates.
A new navigation system for minimally invasive total knee arthroplasty
Acta medica Okayama, 2013
A computer-assisted navigation system to be used for total knee arthroplasties (TKAs) was reported to improve the accuracy of bone resection and result in precise implant placement, but the concomitant surgical invasion and time consumption are clinical problems. We developed a computed tomography (CT)-based navigation system (NNS) to be used for minimally invasive TKA. It requires only the reference points from a small limited area of the medial femoral condyle and proximal tibia through a skin incision to obtain optical images. Here we evaluated the usefulness and accuracy of the NNS in comparison with the commercially available BrainLAB image-free navigation system (BLS). In a clinical experiment, the registration times obtained with the NNS tended to be shorter than those obtained with the BLS, but not significantly so. The NNS group tended to be in the extended position in the sagittal plane of the distal femur within 3 degrees, and the BLS group showed rather flexed deviation ...
Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases
Revista Brasileira de Ortopedia (English Edition), 2014
Objective: to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. Method: a total of 196 patients who underwent total knee arthroplasty with computerassisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months. Results: in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3 • of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. Conclusion: the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.
Evaluation of the Visionaire Instrumentation for Total Knee Arthroplasty Using Computer Navigation
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
and long leg alignment view of the legs for planning and to prepare custom made cutting blocks. All procedures were performed by three consultant orthopaedic surgeons. We looked at the operating time, length of hospital stay and the post-operative long leg alignment radiographs. We compared this with age-and sex-matched cohort of twenty-five patients who had total knee arthroplasty with conventional instrumentation using the same implant type (Geneis 2) by the same surgeons in the previous year. Results: There were 14 males and 11 females in the Visionaire group with a mean age of 68 (52-79) years. The comparison group also had 14 males and 11 females with mean age of 67 (57-80) years. The mean operating time in the Visionaire group was 72 minutes compared to 77 minutes in the comparison knee replacement group. The length of stay in the Visionaire group was 5 days compared to 6 days in the standard knee replacement group. On comparing the long leg alignment view there were 22% outliers in the Visionaire group compared to 40% in the control group and this was statistically significant (chi square test). Discussion: A coronal tibiofemoral angle in excess of AE 3 degrees has been associated with worse functional outcomes and higher rates of implant failure. We have not found any significant difference in the operating time or length of stay in the Visionaire group although the learning curve of the 3 surgeons needs to be taken into consideration. The early trend on the post-operative alignment radiographs shows good post-operative alignment. Despite using this system there are outliers, however the number of outliers can be reduced compared to the standard TKA system. Of note, the cases in the Visionaire group had significant pre-operative deformity and this has caused a selection bias, which could be eliminated by conducting a randomized controlled trial.