No Benefit of Computer-assisted TKA: 10-year Results of a Prospective Randomized Study

Ollivier, Matthieu; Parratte, Sébastien; Lino, Ludovic; Flécher, Xavier; Pesenti, Sébastien; Argenson, Jean-Noël

doi:10.1007/s11999.0000000000000021

Cited by 51 publications

(33 citation statements)

References 28 publications

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“…Several studies have documented a greater survival rate in a navigated group than in a conventional group 10 years after surgery [34, 35]. However, in some studies, no differences were found in long-term survival and the clinical outcomes between navigated TKA and conventional TKA [14, 20, 36, 37]. These discrepant reports may raise a concern that whether improved component and overall limb alignment accuracy guarantee improved clinical and functional outcomes for long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the accelerometer-based navigation system with conventional instruments for total knee arthroplasty: a propensity score-matched analysis

et al. 2019

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Background The accelerometer-based navigation (ABN) system is an emerging navigation system for total knee arthroplasty (TKA). This study aimed to determine whether the ABN system could improve the accuracy of mechanical alignment, component positioning, and short-term clinical outcomes for TKA when compared to conventional instruments (CON). Methods A total of 204 patients were selected and divided into two groups (CON: 135, ABN: 69) after applying the inclusion and exclusion criteria. Then, 1:1 propensity score matching was performed for age, gender, body mass index, hip-knee-ankle angle (HKA), Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) score, and follow-up times. A total of 82 consecutive patients (82 knees) underwent total knee arthroplasty using ABN ( n = 41) or CON ( n = 41) were enrolled in this study. The postoperative HKA, frontal femoral component (FFC) angle, frontal tibial component (FTC) angle, lateral femoral flexion (LFF) angle, and lateral tibial component (LTC) angle were compared between the two groups to evaluate mechanical alignment and component positioning. Additional clinical parameters, including haemoglobin reduction, the KSS, and the WOMAC score, were assessed at the final follow-up (the mean follow-up period was 20.9 months in the CON group and 21.2 months in the ABN group). Results The ABN group had a significantly improved mean absolute deviation of HKA ( P = 0.033), FFC ( P = 0.004), FTC ( P = 0.017), LFF ( P = 0.023), and LTC ( P = 0.031) compared to those of the CON group. The numbers of FFCs and LTCs within 3° were significantly different ( P = 0.021, P = 0.023, respectively) between the two groups. However, no differences in the numbers of FTCs within 3° ( P = 0.166) and LFF within 3° ( P = 0.556) were found. The ABN group had a significantly higher KS function score ( P = 0.032), and the pain and stiffness scores were significantly different ( P = 0.034, P = 0.020, respectively) between the two groups. Moreover, the ABN system could reduce hidden blood loss postoperatively. However, no difference was found in the KS knee score and the total WOMAC score between the two groups. Conclusion This study demonstrates that ABN system improved TKA mechanical alignment and component positioning and decreased the hidden blood loss postoperatively compared to conventional instruments. However, no significant differences were found in short-term clinical outcomes between ABN and conventional instruments at the final follow-up. However, whether this system contributes to revision rates ...

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Section: Discussionmentioning

confidence: 99%

Comparison of the accelerometer-based navigation system with conventional instruments for total knee arthroplasty: a propensity score-matched analysis

et al. 2019

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“…(1) Removal of retained hardware enables use of intramedullary approach, but the surgery duration is longer and it bears the highest rate of side effects – up to 28% [9]. (2) Recently published paper confirms that computer-guided arthroplasty results in lower rate of complications, but long-term observational data does not prove its superiority over traditional technique [10, 11]. Therefore in this case, an extramedullary guide assisted by ultrasound was used to confirm implant’s correct positioning.…”

Section: Resultsmentioning

confidence: 99%

TKA with retained hardware guided by intraoperative ultrasonography – a case report

Poboży¹,

Konarski

Hordowicz

2019

BMC Surg

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Background When a conservative management of gonarthrosis yields unsatisfactory results, a total knee arthroplasty (TKA) is recommended as an alternative approach. The implant survival is crucial for the long-term success of the procedure. However, in case of patients with retained hardware after past orthopedic procedures, providing correct alignment of the implant, which contributes to its longevity, is especially challenging. Here we present the use of an intra-operative ultrasonography for implant positioning in a 83-year-old male, undergoing TKA, without hardware removal, which was contraindicated due to his advanced age and comorbidities. Other imaging modalities taken into consideration are also described. Case presentation The right knee joint was approached with anterior incision. A femoral guide was introduced extramedullary. Ultrasonography was used to pinpoint the center of the femur’s head. Tibial’s guide was introduced intramedullary followed by a standard cut of the proximal part. Cemented ZIMMER NEXGEN prosthesis was used. Layered closure was applied. The placement of implant in neutral axis was confirmed on radiographs. Conclusions Our case demonstrates that ultrasonography might be helpful during TKA-procedure for implant positioning. However, more studies are needed to evaluate accuracy and application of ultrasound in the intraoperative settings.

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“…A number of reports of postoperative outcomes using the KOOS for OWHTO or TKA have been published [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. As published by Roos and Lohmander [ 20 ], the KOOS score represents clinically significant results, as the difference between the 2 groups was greater than the minimal clinically important difference reported in the literature [ [8] , [9] , [10] ].…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty Is Superior to Open Wedge High Tibial Osteotomy in Terms of Pain Relief for Patients With Osteoarthritis

et al. 2021

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Background: Globally, total knee arthroplasty (TKA) is widely performed on patients with osteoarthritis. Meanwhile, open wedge high tibial osteotomy (OWHTO) has garnered attention in our country as a jointpreserving procedure. This study aimed to retrospectively compare the postoperative clinical outcomes of TKA and OWHTO for patients with osteoarthritis. Methods: We selected 94 patients (106 knees) who underwent OWHTO or TKA between 2013 and 2018, had complete clinical data, and were followed up for >2 years. Patients were classified into 2 groups depending on the procedure (TKA: n ¼ 49; OWHTO: n ¼ 45). Patients in the A (¼ arthroplasty) group were significantly older, with a worse range of motion (ROM) than those in the O (osteotomy) group. There were no significant differences regarding sex and body mass index between groups. Operative time, perioperative blood loss, knee ROM, and Japanese Knee Injury and Osteoarthritis Outcome Score (J-KOOS) were compared between the groups. Results: Significant differences were found between the A and O groups regarding operative time (120 ± 27.2 vs 80.3 ± 23.3 minutes), perioperative blood loss (505.4 ± 271.8 vs 322.6 ± 196.1 mL), knee ROM (flexion; 123.4 ± 16.3 vs 133.7 ± 12.8 ), and J-KOOS for pain (87.4 ± 12.5 vs 78.1 ± 15.2 points) and symptoms (86.6 ± 12.3 vs 79.1 ± 13.3 points). There were no significant differences regarding other J-KOOS subscales. Conclusions: OWHTO involved shorter operative times and less blood loss. However, the O group reported less pain relief. The A group represents an older, likely less active patient population. Therefore, OWHTO is a possible joint-preserving treatment options in younger active patients who may not be interested in arthroplasty.

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No Benefit of Computer-assisted TKA: 10-year Results of a Prospective Randomized Study

Abstract: Level III, therapeutic study.

Cited by 51 publications

References 28 publications

Comparison of the accelerometer-based navigation system with conventional instruments for total knee arthroplasty: a propensity score-matched analysis

Comparison of the accelerometer-based navigation system with conventional instruments for total knee arthroplasty: a propensity score-matched analysis

TKA with retained hardware guided by intraoperative ultrasonography – a case report

Total Knee Arthroplasty Is Superior to Open Wedge High Tibial Osteotomy in Terms of Pain Relief for Patients With Osteoarthritis

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