Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Hasegawa, Masahiro; Yoshida, Kakunoshin; Wakabayashi, Hiroki; Sudo, Akihiro

doi:10.1007/s00264-012-1688-1

Cited by 20 publications

(26 citation statements)

References 19 publications

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“…Although this twice cutting method reduced cutting error significantly, there are other causes of tibial malalignment in UKA such as error in setting the cutting guide, keel cutting and implantation [14,17]. These should all be evaluated with a view to achieve optimal alignment both with and without navigation systems.…”

Section: Discussionmentioning

confidence: 97%

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Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty

et al. 2016

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Section: Discussionmentioning

confidence: 97%

“…Using such a navigation system, we can monitor bone cutting error and recut the bone to reduce this error, thereby achieving the planned alignment [14]. However, most surgeons have to perform surgeries without such navigation systems.…”

Section: Introductionmentioning

confidence: 99%

Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty

et al. 2016

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“…[26][27][28][29][30] The theory of a system (iASSIST, Zimmer Inc.; Warsaw, IN) is similar to that of the recommended techniques in this study in terms of defining the tibial coronal alignment by fixing the spikes on the AP axis of the proximal tibia and aligning rotation of the distal clamps around the malleoli to the AP axis of the proximal tibia. Postoperative alignment is the summary of several intraoperative procedures (e.g., positioning of the cutting guide decided by the end of the distal guide, bone resection, 31 and cement fixation 32 ). This study specifically evaluated the effect of the position of the distal end of the extramedullary guide by aligning the distal end of the guide to the AP axis of the proximal tibia.…”

Section: Discussionmentioning

confidence: 99%

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

et al. 2021

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The optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.

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“…Accuracy of the preoperative plan can be improved by a 3D template and accuracy of the reproduction of the plan is improved by the navigation system or by PSI (patient specific instruments). Cutting guide settings also can be improved through use of a navigation system [12] [13]. Inaccurate bone cutting has been noted for a long time.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Initial Bone Cutting in Total Knee Arthroplasty

Ohmori¹,

Maeda²,

Kabata³

et al. 2015

OJO

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Background: The aim of this study was to evaluate the accuracy of initial bone cutting of the distal femur and the proximal tibia in TKA using an image-free navigation system. Methods: From February 2006 to March 2013, we evaluated 60 knees in 50 patients using an image-free navigation system (Navigation: Stryker Navigation Cart System; Software: Stryker Knee Navigation; Ver2.0: Stryker Orthopaedics US NJ Mahwah). First, we measured the angle shown by the navigation system before cutting, at the time we set the jig. Second, we measured the angles shown by navigation after the bone was cut using the jig. Then, we compared these two angles for each patient to determine the bone cutting error. Results: In the distal femur, 37 of 60 knees were cut in an extended position in the sagittal plane, and 26 of 60 knees were cut in a varus in the coronal plane. In the proximal tibia, 29 of 60 knees were cut with decreased posterior slope in the sagittal plane, and 26 of 60 knees were cut in a valgus. Conclusions: In this study, the distal femur tended to be cut in an extended and a varus position and the proximal tibia did with decreased posterior slope and in a valgus position after initial bone cutting. It is necessary to note the initial cutting error in TKA. Since cutting errors affect postoperative outcome, we should cut bones several times. And as the reasons of the cause of the error, we propose new reason that cutting bone is not parallel with accuracy to AP axis.

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Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Cited by 20 publications

References 19 publications

Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty

Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

The Accuracy of Initial Bone Cutting in Total Knee Arthroplasty

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