Intraoperative cutting errors in total knee arthroplasty

Bäthis, H.; Perlick, L.; Tingart, Markus; Perlick, Carsten; Lüring, C.; Grifka, Joachim

doi:10.1007/s00402-004-0759-1

Cited by 84 publications

(84 citation statements)

References 17 publications

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“…Using traditional intramedullary alignment systems, deviations of up to 8°can occur in the femoral axis, depending on the size and length of the intramedullary guide [17]. Unstable cutting blocks and saw deviation during osteotomy have been shown to result in cutting errors [1,17]. In 2001, Mahaluxmivala et al showed that TKR alignment is improved with surgical experience [14].…”

Section: Discussionmentioning

confidence: 99%

“…Computer-assisted surgery provides the surgeon with continuous intraoperative feedback on implant alignment and cutting errors during all phases of TKR [1]. A reduction in cutting errors has been shown when a navigation system is used for TKR surgery [17].…”

Section: Discussionmentioning

confidence: 99%

“…Greater than 3°varus or valgus mal-alignment in total knee replacement (TKR) can result in higher failure rates whilst correct alignment has been associated with improved clinical outcome [7,11,19]. Several authors have shown that traditional hand-guided alignment systems can produce potential errors in the bone cutting process even when used by experienced surgeons [1,2,14,[16][17][18]21]. Recently, Manley et al showed that patients undergoing TKR in low volume hospitals (1-25 procedures/year) had a higher risk of early revision at five and eight years compared with those performed in the highest volume hospitals (>200 procedures/year) [15].…”

Section: Introductionmentioning

confidence: 99%

“…Computer navigation provides continuous feedback during all phases of the knee replacement surgery providing an opportunity to correct any bone cutting errors. It has been suggested that computer navigation could be used as a teaching tool and result in superior results even for the occasional TKR surgeon [1,4,8]. In 2008, Yau et al, in a retrospective study, failed to show any improvement in postoperative alignment using a computer-assisted technique in a low volume knee practice [25].…”

Section: Introductionmentioning

confidence: 99%

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

Manzotti

Cerveri

Momi

et al. 2009

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Manzotti

Cerveri

Momi

et al. 2009

International Orthopaedics (SICOT)

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“…Furthermore, decisions regarding bony resection level are based on measurements taken using a traditional jig and rod, and thus, anterior notching and femoral component oversizing can be avoided. Unfortunately, the conventional technique is more inaccurate and inconsistent in terms of its component alignment ability than computer navigation [5,6]. In this paper, we describe a hybrid technique that combines the benefits of computer navigation and conventional TKA.…”

Section: Introductionmentioning

confidence: 99%

Total Knee Arthroplasty Using a Hybrid Navigation Technique

Ong¹,

Jung²,

Orozco³

et al. 2013

Reconstructive Review

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The use of computer navigation is becoming a well-recognized technical alternative to conventional total knee arthroplasty (TKA). However, computer navigation has a substantial learning curve and the use of commercially available navigation systems increases surgical time. In addition, the potential risks associated with the navigation TKA, such as, registration errors, notching of the anterior femoral cortex, oversizing of the femoral component, and overresection must be taken into consideration. On the other hand, conventional techniques are familiar and intuitive to most practicing surgeons, and thus, are easier to perform and are less prone to anterior notching and femoral component oversizing. However, conventional techniques have greater risks of inaccurate and inconsistent component alignment than computer navigation. This paper describes a novel technique that combines computer navigation and conventional TKA.

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Precise landmarking in computer assisted total knee arthroplasty is critical to final alignment

Brin

Livshetz

Antoniou

et al. 2010

Journal Orthopaedic Research

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Image-free computer navigation systems build a frame of reference of a patient's knee from anatomical landmarks entered by the surgeon during the initial stage of total knee arthroplasty. We performed tibial cuts on 70 sawbones using computer navigation. All landmarks were marked identically except for the tibial mechanical entry point, which was marked correctly in 10 bones and with offsets of 5, 10, and 15 mm medially and laterally in the others. The actual coronal angle of the tibial cuts was measured directly and compared to the final angle given by the navigation system. Significant deviations of the coronal angle were observed in the trial groups. Landmarking errors during navigated TKA can lead to inaccurate tibial bone cuts. This navigation system did not have an iterative software method to verify landmarking errors that can lead to inaccurate tibia bone cuts. Keywords: computer assisted orthopedic surgery; total knee arthroplasty; navigation system; saw bones; landmarkingThe outcome of total knee arthroplasty (TKA) is particularly sensitive to variations in surgical technique. 1,2 Incorrect implant positioning and improper limb alignment may lead to implant loosening. A number of alignment mistakes can occur during the bone cuts and prosthesis implantation. Tibial bone cuts that are in varus by >38 are associated with rapid failure and reduced functional results. 3-5 Patellar instability can be caused by malrotation of the femoral prosthesis. 6 Errors of this type are estimated to occur in at least 10% of TKA even when performed by experienced surgeons using modern mechanical alignment systems (intramedullary or extramedullary methods). Outliers are especially common when severe bony deformity or dysplasia exists. 7,8 The use of computer assisted orthopedic surgery (CAOS) for TKA has reduced the number of outliers in mechanical axis alignment. 9 There are three main types of navigation systems: pre-op image-based (CT-based), intra-op image-based (radiograph, no CT), and intra-op image-free (no CT or radiograph). 10 Image free navigation avoids the expense and radiation associated with pre-op CT and the extra OR time and personnel required for intra-op radiographs. A critical aspect of image-free CAOS TKA is the data acquisition stage, during which data are collected to build a reference frame of the patient's knee. Trackers attached to the bones are seen by the system throughout surgery and allow it to provide real-time spatial anatomic information. Most systems prompt the surgeon to visually select several anatomic landmarks by using a mechanical pointer attached to an infrared tracker: mechanical entry point of the distal femur (entry point of the femoral medullary canal), mechanical entry point of the proximal tibia (entry point of the tibial medullary canal), anterior femoral cortex, posterior and distal portions of the femoral condyles, medial and lateral tibial plateau, tibial tuberosity, and medial and lateral malleoli. The femoral epicondylar axis and Whiteside's line are also often u...

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Intraoperative cutting errors in total knee arthroplasty

Cited by 84 publications

References 17 publications

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

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

Total Knee Arthroplasty Using a Hybrid Navigation Technique

Precise landmarking in computer assisted total knee arthroplasty is critical to final alignment

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