Navigation Improves Accuracy of Rotational Alignment in Total Knee Arthroplasty

Stöckl, B.; Nogler, Michaël; Rosiek, R.; Fischer, Martin; Krismer, Martin; Kessler, Oliver

doi:10.1097/01.blo.0000136835.40566.d9

Cited by 274 publications

(167 citation statements)

References 30 publications

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“…A power analysis was conducted to determine the required sample size. Because the reported percentages of satisfactory lower limb mechanical alignment were 70% to 75% in the majority of conventional technique TKA series [1-3, 5-10, 12, 13, 16-24, 28, 29, 31-34] and 90% to 100% in computer navigation TKA series [1,17,22,23,28,29,34], it was assumed there should be an improvement in satisfactory alignment of at least 15% using the computer navigation technique. The sample size estimation was performed using a power of 80%, a level of significance of 5%, an estimate of a significant reduction of 15% of outliers greater than 3°i n mechanical alignment of the lower limb in the computer navigation group when compared with the conventional jig-based group, and an estimate of a standard deviation of 30% in the variation of reported results in the conventional jig-based series.…”

Section: Methodsmentioning

confidence: 99%

“…We identified 13 clinical series for comparison with the current navigation series (Table 2). Seven studies were prospective, randomized studies [1,7,23,25,28,29,34] and six were retrospective case-control series [2,12,17,[20][21][22]. We compared the characteristics of the patients and the radiographic results of the current case series with those in the literature.…”

Section: Methodsmentioning

confidence: 99%

“…If an outlier in the lower limb mechanical alignment is defined as greater than 3°from the neutral position, the majority of the TKA series performed using the conventional jig-based technique reported a satisfactory alignment rate of approximately 70% [1-3, 5-10, 12, 13, 16-24, 28, 29, 31-34]. However, the results of most of the computer navigation TKA series were much more favorable, reporting satisfactory alignment of 90% to 100% [1,17,22,23,28,29,34]. Some surgeons have suggested this improved predictability of postoperative radiographic alignment with computer navigation TKA occurs with experienced and inexperienced surgeons [30].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Yau

Chiu

Zuo

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Postoperative alignment of the implanted prosthesis in computer-navigated TKA has been reported to be superior to that using the conventional technique. There is an assumption that use of computer navigation techniques can make an inexperienced or occasional TKA surgeon perform more like an expert TKA surgeon. To assess improved accuracy in recreation of mechanical alignment in TKA performed using computer navigation, a retrospective review of the experience of one of the authors (WPY) before and after using computer navigation was performed. We reviewed the radiographic results of 104 TKAs (52 computer navigation, 52 conventional technique) and found the accuracy of postoperative radiographic alignment of the implanted prosthesis was not improved by using computer navigation as judged by (1) overall limb alignment (case: varus 1.3°; control: varus 0.3°); (2) femoral component alignment (case: 90.3°; control: 90.3°); and (3) tibial component alignment (case: 89°; control: 90°). Significant factors that affected postoperative overall mechanical alignment in the current navigation series included severity of the preoperative deformity, amount of error in making bone cuts, and experience of the surgeon in using the computer navigation system. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Yau

Chiu

Zuo

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Refinements in surgical technique and instrumentation and surgical navigation systems have improved component alignment [7,19,50,51,54]. Soft-tissue balance remains an art, largely driven by the surgeon's experience.…”

Section: Intraoperative Usementioning

confidence: 99%

“…Current-generation computer-aided surgical navigation systems cannot directly address soft-tissue balance and knee tightness [48,50,51]. An instrumented tibial prosthesis can enhance the value of such navigation tools in achieving reproducible clinical outcomes.…”

Section: Intraoperative Usementioning

confidence: 99%

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

D’Lima

Patil

Steklov

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid. Questions/purposes We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory. Methods Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A thirdgeneration system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware. Results By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (À12 to +4 mm), mediolateral translation (À1 to 1.5 mm), axial rotation (À3°to 12°), and adduction-abduction (À1°t o +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy. Conclusions Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

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Computer‐assisted revision total knee arthroplasty does not improve postoperative knee prosthesis alignment compared to the conventional technique

Alling,

Conteh‐Meijer,

Boerboom

et al. 2024

J. exp. orthop.

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PurposeComputer‐assisted surgery (CAS) during primary total knee arthroplasty (TKA) prosthesis alignment. However, literature on its use during revision TKA (rTKA) is scarce. Moreover, the effect of CAS during rTKA on rotational alignment of the prosthesis has not been described yet. The purpose of this study was to assess the effect of CAS during rTKA, focusing on the number of outliers and coronal, sagittal and rotational prosthetic alignment compared to conventional rTKA.MethodsA prospective cohort study comparing CAS‐rTKA with a historical control group (CON‐rTKA). The CAS‐rTKA group (54 patients/62 knees) underwent rTKA using imageless CAS between 2012 and 2017. The CON‐rTKA group (13 patients/23 knees) was operated using the conventional technique between 2002 and 2012. Postoperative alignment was measured using the EOS‐2D/3D system (coronal and sagittal planes) and computed tomography scan (rotation).ResultsNo significant differences between the CAS‐rTKA and CON‐rTKA groups were found for coronal and sagittal alignment regarding the mechanical angle of the leg (p = 0.08), mechanical lateral distal femoral angle (p = 0.87), mechanical medial proximal tibial angle (p = 0.40), anatomical proximal posterior tibial angle (p = 0.43) nor femoral (p = 0.80) and tibial rotation (p = 0.15). For the proportions of coronal, sagittal and rotational outliers, no significant differences were found either.ConclusionThis study showed no evidence that use of CAS during rTKA leads to improved coronal, sagittal or rotational alignment of knee prostheses or a difference of outliers between the groups.Level of EvidenceLevel III, therapeutic.

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Navigation Improves Accuracy of Rotational Alignment in Total Knee Arthroplasty

Cited by 274 publications

References 30 publications

Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

Computer Navigation Did Not Improve Alignment in a Lower-volume Total Knee Practice

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

Computer‐assisted revision total knee arthroplasty does not improve postoperative knee prosthesis alignment compared to the conventional technique

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