Using Accelerometer-Based Portable Navigation to Perform Accurate Total Knee Arthroplasty Bone Resection in Asian Patients

Abstract

Implant alignment is an important factor affecting clinical results associated with total knee arthroplasty (TKA). No report exists showing the utility of an accelerometer-based portable navigation system among patients with marked femoral bowing. The aim of this study was to evaluate the accuracy of a portable navigation system for implant alignment in Asian patients with marked femoral bowing. The authors evaluated 142 consecutive TKAs performed for primary osteoarthritis since July 2013. A portable navigation system was used in 67 knees, and a conventional jig was used in 75 knees. The authors measured the mechanical axis and femoral/tibial component alignments on long-leg radiographs obtained 2 weeks after TKA. In addition, coronal bowing of the lower limb was evaluated. The results were analyzed in the general and marked femoral bowing subgroups. There were no significant differences between the 2 groups for demographic data. The rates of femoral component outliers in the coronal plane for the navigation system and conventional technique were 1.5% and 13.3% (P=.01), respectively. Marked femoral bowing was observed in 73 knees. In the subgroup of patients with marked femoral bowing, femoral coronal alignment and its outliers were more accurate in the navigation group (0%) than in the conventional group (16.2%) (P=.025). This is the first report to show the utility of an accelerometer-based portable navigation system for accurate prosthetic alignment among Asian patients with marked femoral bowing. The navigation system decreased outliers in coronal alignment of the femur, even in cases of marked femoral bowing, but did not increase complications. [Orthopedics. 2017; 40(3):e465-e472.].

Efficacy of Portable Accelerometer-Based Navigation Devices versus Conventional Guides in Total Knee Arthroplasty: A Meta-analysis

“…[8][9][10][15][16][17][18][19][20][21][22][23][24] Among the included studies, six were RCTs, 8,10,17,19,21,23 one was a prospective study, 16 and six were retrospective studies. 9,15,18,20,22,24 The present meta-analysis analyzed 1,454 patients with 1,551 TKAs (mean sample size, 119.31 TKAs per study). None of the included studies contained revision or failure cases.…”

“…Eight studies with nine groups reported a tibial component alignment out of AE3 degrees [8][9][10]15,16,19,22,24 ; the pooled result indicated that PAD was better than CON with significant differences (OR, 0.56; 95% CI, 0.33-0.93; p ¼ 0.02; outlier percentage, PAD/CON ¼ 5.36%/10.00%) (►Fig. 2A).…”

“…2C). [8][9][10]15,[22][23][24] Two studies reported the tibial component posterior slope out of AE2 degrees. 10,21 After pooling the results, the two techniques were found to be comparable (OR, 0.95; 95% CI, 0.39-2.32; p ¼ 0.91; outlier percentage: PAD/ CON ¼ 7.94%/8.33%) (►Fig.…”

“…Nonrandomized studies The results of femoral coronal angles were also analyzed. Ten studies with 11 groups reported a femoral coronal angle out of AE3 degrees, [8][9][10][15][16][17][18][19]22,24 and the result of the analysis revealed that the PAD group was much more accurate than the CON group (OR, 0.30; 95% CI, 0.14-0.64; p ¼ 0.002; hetero-geneity was found and random-effects model was used; outlier percentage: PAD/CON ¼ 5.32%/15.98%) (►Fig. 3A).…”

“…Ten studies reported the results of tibial component alignment, [8][9][10]15,16,19,20,[22][23][24] revealing a small difference between PAD and CON groups after pooling the results (MD, 0.02; 95% CI, À0.29 to 0.33; p ¼ 0.89; heterogeneity was found and the random-effects model was used). Sensitivity analysis showed that the heterogeneity could not be eliminated by rejecting any single study.…”