Technical and surgical causes of outliers after computer navigated total knee arthroplasty

Shah, Siddharth; Sciberras, Nadia C.; Allen, David J.; Picard, F.

doi:10.1016/j.jor.2019.10.016

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…Any movement of the pelvis during circumduction could cause hip center rotation definition errors too [ 43 ]. Additionally, a stiff hip due to any aetiology that precludes an unrestricted hip circumduction is another plausible cause of hip center errors [ 44 ], though in the current study, such patients were excluded for analysis. Similarly, errors in ankle center registration may be responsible for tibial component outliers [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a stiff hip due to any aetiology that precludes an unrestricted hip circumduction is another plausible cause of hip center errors [ 44 ], though in the current study, such patients were excluded for analysis. Similarly, errors in ankle center registration may be responsible for tibial component outliers [ 44 ]. Third, sometimes the surgeon had accepted residual malalignment during surgery as understood from the navigation data to obtain a balanced extension and/or flexion space.…”

Section: Discussionmentioning

confidence: 99%

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The accelerometer-based navigation system demonstrated superior radiological outcomes in restoring mechanical alignment and component sagittal positioning in total knee arthroplasty

Gao

Hou

et al. 2021

BMC Musculoskelet Disord

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Background This study aimed to determine whether the accelerometer-based navigation (ABN) could improve the accuracy of restoring mechanical axis (MA), component positioning, and clinical outcomes compared to conventional (CON) total knee arthroplasty (TKA). Methods A total of 301 consecutive patients (ABN: 27, CON: 274) were included. A 1:4 propensity score matching (PSM) was performed between the two groups according to preoperative demographic and clinical parameters. The postoperative MA, femoral coronal angle (FCA), femoral sagittal angle (FSA), tibial coronal angle (TCA) and tibial sagittal angle (TSA) were compared. Absolute deviations of aforementioned angles were calculated as the absolute value of difference between the exact and ideal value and defined as norms if within 3°, otherwise regarded as outliers. Additional clinical parameters, including the Knee Society knee and function scores (KSKS and KSFS) and range of motion (ROM), were assessed at final follow-up (FU) (mean FU was 21.88 and 21.56 months respectively for ABN and CON group). A secondary subgroup analysis and comparison on clinical outcomes were conducted between norms and outliers in different radiological parameters. Results A total of 98 patients/102 knees were analyzed after the PSM (ABN: 21 patients/24 knees, CON: 77 patients/78 knees). In the ABN group, the mean MA, FCA and TSA were significantly improved (p = 0.019, 0.006, < 0.001, respectively). Proportions of TKAs within a ± 3°deviation were significantly improved in all the postoperative radiological variables except for TCA (p = 0.003, 0.021, 0.042, 0.013, respectively for MA, FCA, FSA, and TSA). The absolute deviations of FSA and TSA were also significantly lower in the ABN group (p = 0.020, 0.048, respectively). No significant differences were found in either mean value, absolute deviation or outlier ratio of TCA between two groups. On clinical outcomes, there were no significant differences between two groups, although KSKS, KSFS and ROM (p < 0.01, respectively) dramatically improved compared to baseline. The subgroup analysis also demonstrated no statistical difference on clinical outcomes between the outliers and norms in varied radiological parameters. Conclusions The ABN could improve the accuracy and precision of mechanical alignment and component positioning without significant improvement of clinical outcomes. Further high quality studies with long term FU are warranted to comprehensively evaluate the value of the ABN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The accelerometer-based navigation system demonstrated superior radiological outcomes in restoring mechanical alignment and component sagittal positioning in total knee arthroplasty

Gao

Hou

et al. 2021

BMC Musculoskelet Disord

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“…Optimal positioning of the femoral component in the sagittal plane has not yet been defined [ 13 , 14 ]. Surgeons using navigation, for sagittal positioning of femoral component, continue to make the distal femoral cut perpendicular to SMX [ 8 , 9 ], although studies have shown that this can increase the risk of notching in navigated TKA [ 6 , 12 ]. The present study intends to determine, by opting to place the femoral component perpendicular to DCX rather than perpendicular to SMX, if one can reduce the incidence and depth of notching in navigated TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Studies show that the angle between the DCX and SMX varies widely [ 2 – 4 ], and this can influence the sagittal placement of the femoral component in total knee arthroplasty (TKA) [ 5 ]. Further, in navigated TKA, the optimal sagittal alignment of the femoral component is still unknown [ 6 ], and most surgeons to date plan to align it either perpendicular [ 7 – 9 ] or in slight (3–5°) flexion [ 10 , 11 ] to SMX. However, studies show that the risk of anterior femoral notching is high if the femoral component positioning is planned perpendicular to the SMX in navigated TKA [ 6 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Kanna¹,

Ravichandran²,

Shetty

2021

Knee Surg & Relat Res

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Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence Therapeutic level II.

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“…Mooney et al [ 33 ] showed that navigation-enhanced instrumentation significantly reduced the total outlier rate (±2°/2 mm) as compared to conventional instrumentation. Outliers (±3°) in terms of implant and limb alignment do occur after navigated TKA with a reported incidence of 10.4% [ 34 ] and can be attributed to the surgeon or the navigation system. Errors or inaccuracies during the registration process, especially during the registration of femoral epicondyles, will provide erroneous data to the surgeon which may result in malalignment [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Shah

2021

Arthroplasty

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Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.

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Technical and surgical causes of outliers after computer navigated total knee arthroplasty

Cited by 10 publications

References 28 publications

The accelerometer-based navigation system demonstrated superior radiological outcomes in restoring mechanical alignment and component sagittal positioning in total knee arthroplasty

The accelerometer-based navigation system demonstrated superior radiological outcomes in restoring mechanical alignment and component sagittal positioning in total knee arthroplasty

Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

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