Computerised and technical navigation in total knee-arthroplasty

Abstract

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.

A vascular complication in computer navigated total knee arthroplasty

“…There have been a number of studies reporting complications of computer navigated TKA among these. Böhling et al .,9 Chin et al .,10 and Bäthis et al 11. demonstrated longer tourniquet time with computer navigation.…”

Computer and Template Assisted Orthopedic Surgery

“…Since its inception over a decade ago, the goal of more accurate prosthesis placement has routinely been met (Bäthis et al 2004a(Bäthis et al , 2004bBohling et al 2005;Chauhan et al 2004aChauhan et al , 2004bChin et al 2005;Krackow et al 2003;Oberst et al 2003;Saragaglia et al 2001;Sparmann et al 2003;Stulberg et al 2000Stulberg et al , 2002. Although the original prediction of higher longevity with more accurate placement and even distribution of forces has not yet been proven, a meta-analysis of 29 studies of computer-assisted surgery (CAS) vs. standard mechanically instrumented total knee arthroplasty (TKA) showed that errors of 3° occurred in 9% of the former procedures vs. 31.8% of the latter.…”

Clinical and radiographic outcomes of Image-Based Computer-Assisted Total Knee Arthroplasty: An Evidence-based Evaluation

“…Of these, only 6 [22][23][24][25][26][27] were RCTs or qRCT qualified with 3 from Germany, 22,24,26 and the 1 each from Japan, 23 Belgium, 25 and Switzerland. 27 Five [22][23][24]26,27 of these 6 used the computed tomography (CT)-based navigation system, whereas one 25 used the fluoroscopy-based navigation system. All 6 were randomized, but only one 25 had adequate randomization procedure (block randomization).…”

“…All 6 were randomized, but only one 25 had adequate randomization procedure (block randomization). The other 5 studies [22][23][24]26,27 were randomized based on inappropriate method, including date of surgery, alternation, and availability of equipment. Table 1 presents the characteristics of all included studies.…”

“…However, until now, there are no published system review and meta-analysis to exclusively analyze the advantages and disadvantages of the use of the imagebased navigation system. Several RCTs/qRCTs [22][23][24][25][26][27] have arrived at different results in the past few years, but many of these trials have been compromised by the small number of patients and in some cases, the relatively rare occurrence of complications. Consequently, drawing any conclusions on the effectiveness of the image-based navigation system in TKA is difficult.…”