Computer-Assisted Techniques Versus Conventional Guides for Component Alignment in Total Knee Arthroplasty

Blakeney, William G.; Khan, Riaz J.K.; Wall, Simon J.

doi:10.2106/jbjs.i.01321

Cited by 138 publications

(89 citation statements)

References 14 publications

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“…Long term, malalignment might increase the risk of loosening, instability, wear, and osteolysis [1-3, 6, 9, 18, 20, 24, 30-32]. After a decade of clinical use, computerassisted navigation has resulted in improved alignment but has not eliminated outliers and has not improved the clinical outcome [4,7,26,35]. One recent alternative has been the development of patient-specific instrumentation using MRI or CT imaging to generate patient-specific guides that can be used intraoperatively to control all six degrees of freedom of component alignment, which also controls limb and knee alignment.…”

Section: Introductionmentioning

confidence: 99%

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Nunley

Ellison

Zhu

et al. 2012

Clinical Orthopaedics &Amp; Related Research

211

175

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Background Coronal alignment may impact clinical outcome and survivorship in TKA. Patient-specific instrumentation has been developed to restore mechanical or kinematic axis and potentially reduce component malpositioning. Although it is clear these instruments add cost, it is unclear whether they improve alignment. Questions/purposes We determined whether the mean coronal alignment after TKA performed with conventional versus patient-specific instrumentation better restored the mechanical and kinematic axes and whether there were more outliers with one of the two methods. Methods We retrospectively evaluated 150 primary TKAs performed for osteoarthritis: Group 1 (n = 50) conventional instrumentation; Group 2 (n = 50) patientspecific instrumentation restoring the mechanical axis; Group 3 (n = 50) patient-specific instrumentation restoring the kinematic axis, and measured femorotibial angle, hipknee-ankle angle, and the zone of the mechanical axis from scout CT images taken 0 to 6 weeks postoperatively.

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Section: Introductionmentioning

confidence: 99%

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Nunley

Ellison

Zhu

et al. 2012

Clinical Orthopaedics &Amp; Related Research

211

175

View full text Add to dashboard Cite

show abstract

“…In the literature, many studies have investigated the accuracy of bone cuts in TKA according to many conventional guide systems and navigation systems and comparison of them. [7][8][9] Each cuts in TKA has its own special science and each cut can affect the other cuts and potentially the outcome of the TKA. [10] While coronal alignment and clinical outcome has been extensively investigated, the ideal alignment in sagittal plane has been mostly overlooked.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of two different extra-medullary tibial cutting guides for posterior tibial slope in total knee arthroplasty

Bek

Ege

Yıldız

et al. 2014

Eklem Hastalik Cerrahisi

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“…This surgical assistance is becoming more frequently used in limb salvage surgery to preserve as much host tissue as possible without compromising tumor margins and may help surgeons perform more accurate resections [11,15,16,18]. However, previous reports about navigation in trauma and arthroplasty have suggested that computer assistance techniques do not improve patient-reported outcomes and that these techniques add surgical time [6,8,13,20]. Intraoperative problems and increased surgical time might be expected with the adoption of new technology, and a learning curve may apply to surgeons who attempt new methods like navigation [1,12,17].…”

Section: Introductionmentioning

confidence: 99%

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

Farfalli

Albergo

Ritacco

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Computer navigation during surgery can help oncologic surgeons perform more accurate resections. However, some navigation studies suggest that this tool may result in unique intraoperative problems and increased surgical time. The degree to which these problems might diminish with experience-the learning curve-has not, to our knowledge, been evaluated for navigation-assisted tumor resections. Questions/purposes (1) What intraoperative technical problems were observed during the first 2 years using navigation? (2) What was the mean time for navigation procedures and the time improvement during the learning curve? (3) Have there been any differences in the accuracy of the registration technique that occurred over time? (4) Did navigation achieve the goal of achieving a wide bone margin? Methods All patients who underwent preoperative virtual planning for tumor bone resections and operated on with navigation assistance from 2010 to 2012 were prospectively collected. Two surgeons (GLF, LAA-T) performed the intraoperative navigation assistance. Both surgeons had more than 5 years of experience in orthopaedic oncology with more than 60 oncology cases per year per surgeon. This study includes from the very first patients performed with navigation. Although they did not take any formal training in orthopaedic oncology navigation, both surgeons were trained in navigation for knee prostheses. Between 2010 and 2012, we performed 124 bone tumor resections; of these, 78 (63%) cases were resected using intraoperative navigation assistance. During this period, our general indications for use of navigation included pelvic and sacral tumors and those tumors that were reconstructed with massive bone allografts to obtain precise matching of the host and allograft osteotomies. Seventy-eight patients treated with this technology were included in the study. Technical problems (crashes) and time for the navigation procedure were reported after surgery. Accuracy of the registration technique was defined and the surgical margins of the removed specimen were determined by an experienced bone pathologist after the surgical procedure as intralesional, marginal, or wide margins. To obtain these One of the authors certifies that he (LAA-T) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Stryker Americas (Miramar, FL, USA 123 Clin Orthop Relat Res (2017) 475:668-675 DOI 10.1007/s11999-016-4761-z Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® data, we performed a chart review and review of operative notes.Results In four patients (of 78 [5%]), the navigation was not completed as a result of technical problems; all occurred during the first 20 cases of the utilization of this technology. The mean time for navigation procedures during the operation was 31 minutes (range, 11-61 minutes), and the early navigations took more time (the regression analysis shielded R 2 = 0.35 ...

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Computer-Assisted Techniques Versus Conventional Guides for Component Alignment in Total Knee Arthroplasty

Cited by 138 publications

References 14 publications

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

The accuracy of two different extra-medullary tibial cutting guides for posterior tibial slope in total knee arthroplasty

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

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