Radiographic Results of an Accelerometer-based, Handheld Surgical Navigation System for the Tibial Resection in Total Knee Arthroplasty

Nam, Denis; Cross, Michael B.; Deshmane, Prashant; Jerabek, Seth A.; Kang, Michael N.; Mayman, David J.

doi:10.3928/01477447-20110826-12

Cited by 27 publications

(26 citation statements)

References 21 publications

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“…Previous studies have reported that this device places 95-97% of tibial components within ±2°of a neutral mechanical axis [22,23,25], and 95% of tibial components are within ±2°of 3°of posterior slope [22].…”

Section: Introductionmentioning

confidence: 92%

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Steinhaus

McLawhorn

Richardson

et al. 2016

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. Questions/Purposes: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). Methods: After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests. Results: Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1°of neutral for both groups, although statistically different (p = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p = 0.004); PSI resulted in significantly more outliers (>6°; p = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p = 0.023). Conclusion: NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patientreported outcomes and TKA survivorship is controversial and should be the focus of future research.

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Section: Introductionmentioning

confidence: 92%

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Steinhaus

McLawhorn

Richardson

et al. 2016

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…Preliminary results have been encouraging, but additional, comparative studies are required to prove its efficacy. [17][18][19]…”

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confidence: 99%

Patient-Specific Instrumentation in Total Knee Arthroplasty: A Review

et al. 2012

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Recently, patient-specific approaches to total knee arthroplasty (TKA) have been introduced, in which preoperative imaging (plain radiographs, computed tomography [CT], and magnetic resonance imaging [MRI]) are used to manufacture cutting blocks specific to a patient's anatomy. Proposed benefits of patient-matched cutting blocks include a decrease in operative time, instrument trays required, and the ability to preoperatively plan a patient's component size, position, and alignment. In addition, an improvement in postoperative mechanical alignment is expected, without violation of the intramedullary (IM) canal. However, questions remain regarding patient outcomes and the cost-effectiveness associated with patientspecific cutting block technology. This article will review the evolution of surgical techniques in TKA, the development of patient-specific cutting blocks, surgical considerations, and the literature associated with this new technology. An Evolution of Surgical TechniquesAlthough TKA has been a tremendously successful procedure in the management of degenerative joint disease, tibial and femoral component malalignment remains a significant concern. Berend et al has shown that a tibial varus alignment of >3 degrees increased the odds of implant failure and medial bone collapse by roughly 17 times, emphasizing the importance of accurate tibial component positioning on TKA survivorship. 1 Recently, Ritter et al, in a review of 6070 TKAs, noted that the risk of aseptic failure increased if the orientation of the tibial component was <90 degrees relative to the tibial axis, and the orientation of the femoral component was >8 degrees of valgus (failure rate 8.7%). In addition, they noted that "correction" of varus or valgus malalignment of the first implanted component by placement of the second component, to attain a neutral tibiofemoral alignment, was associated with increased failure rates, indicating that optimal positioning of both the femoral and tibial components is crucial. 2 With the increasing prevalence of total joint replacements performed in the United States, the projected increase in revision total knee surgery has been estimated to be 412% by the year 2030. Therefore, improved surgical techniques to prevent malalignment may prove cost-effective. 3 Currently, the instruments most commonly used in TKA are an extramedullary (EM) alignment guide for the tibial resection, and an IM alignment guide for the distal femoral Keywords ► total knee arthroplasty ► patient-specific instrumentation ► alignment ► cost-effectiveness AbstractRecently, patient-specific approaches to total knee arthroplasty (TKA) have been introduced, in which preoperative imaging (plain radiographs, computed tomography, and magnetic resonance imaging) are used to manufacture cutting blocks specific to a patient's anatomy. Proposed benefits of patient-matched cutting blocks include a decrease in operative time, instrument trays required, and the ability to preoperatively plan a patient's component size, position, and alignment. In ...

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“…It consists of a KneeAlign 2 TM display console (Figure 1), a reference sensor, and a femoral jig. The original KneeAlign TM device was created for use in performing the proximal tibia resection in TKA, and has demonstrated encouraging clinical results [15,16]. The KneeAlign 2 TM device is an adaptation of the same technology, but required the additional design of a femoral jig and cutting block.…”

Section: Methodsmentioning

confidence: 99%

Cadaveric analysis of an accelerometer-based portable navigation device for distal femoral cutting block alignment in total knee arthroplasty

Nam

Jerabek

Cross

et al. 2012

Computer Aided Surgery

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Femoral intramedullary guides have been shown to be insufficiently accurate in creating a distal femoral resection perpendicular to the mechanical axis in total knee arthroplasty (TKA), as they make assumptions regarding the difference between the patient's femoral mechanical and anatomical angles. The aim of this cadaveric study was to validate the accuracy of a portable accelerometer-based navigation device for alignment of the distal femoral cutting block in TKA. Twenty-nine trials were performed on five cadaveric specimens (hip-to-ankle), in which the distal femoral cutting block was placed using the KneeAlign 2™ navigation device. For each specimen, a preoperative "target" was assigned for varus/valgus and flexion/extension alignment of the cutting block. The actual alignment of each cutting block was then measured using the ORTHOsoft Computer Assisted Surgery (CAS) system. The mean absolute difference between the preoperative target and the alignment of the cutting block was 0.83 ± 0.60° for varus/valgus, and 0.83 ± 0.83° for flexion/extension. The KneeAlign 2™ navigation device can set and align the distal femoral resection guide with the same accuracy as a large-console CAS system, thus demonstrating that portable accelerometer-based navigation can be used reliably in total knee arthroplasty.

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Radiographic Results of an Accelerometer-based, Handheld Surgical Navigation System for the Tibial Resection in Total Knee Arthroplasty

Cited by 27 publications

References 21 publications

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Patient-Specific Instrumentation in Total Knee Arthroplasty: A Review

Cadaveric analysis of an accelerometer-based portable navigation device for distal femoral cutting block alignment in total knee arthroplasty

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