Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-08-2014 | Knee

Less outliers in pinless navigation compared with conventional surgery in total knee arthroplasty

Authors: Jerry Yongqiang Chen, Pak Lin Chin, Darren Keng Jin Tay, Shi-Lu Chia, Ngai Nung Lo, Seng Jin Yeo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2014

Abstract

Purpose

The aim of this study was to investigate the effectiveness of a new pinless navigation system (BrainLAB^® VectorVision^® Knee 2.5 Navigation System) as an intra-operative alignment check in total knee arthroplasty using conventional cutting jigs.

Methods

200 patients who underwent total knee arthroplasty using conventional technique or pinless navigation by a senior surgeon were included in the study and prospectively followed up. Intra-operative readings from the pinless navigation system were recorded, and post-operative long limb radiographic films were taken. The accepted values for normal alignment were 180 ± 3° for Hip-Knee-Ankle Angle and 90 ± 3° for Coronal Femoral-Component Angle or Coronal Tibia-Component Angle.

Results

There was no difference in the duration of surgery. The mean Coronal Femoral-Component Angle was 89.8 ± 2.0° and 91.3 ± 2.3° in the pinless navigation and conventional group, respectively (p < 0.001). For Hip-Knee-Ankle Angle, the proportion of outliers was 10 % in the pinless navigation group compared to 26 % in the conventional group (p = 0.005). For Coronal Femoral-Component Angle and Coronal Tibia-Component Angle, the proportion of outliers was 7 and 4 %, respectively, in the pinless navigation group, compared to 22 and 19 % in the conventional group (p = 0.004 and p = 0.001, respectively). The measurements of Coronal Femoral-Component Angle and Coronal Tibia-Component Angle on post-operative radiographic films were similar to intra-operative readings.

Conclusions

This study showed that pinless navigation is an effective tool for reducing the proportion of outliers, without significantly increasing the duration of surgery. The authors recommend its use in total knee arthroplasty using conventional cutting jigs.

Level of evidence

III.

Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement: a meta-analysis. J Bone Jt Surg Am 89(2):261–269CrossRef

Beldame J, Boisrenoult P, Beaufils P (2010) Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res 96(3):249–255PubMedCrossRef

Berning ET, Fowler RM (2011) Thermal damage and tracker-pin track infection in computer-navigated total knee arthroplasty. J Arthroplast 26(6):977.e21–977.e214

Bonutti P, Dethmers D, Stiehl JB (2008) Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 466:1499–1502PubMedCentralPubMedCrossRef

Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J (2011) Imageless computer assisted versus conventional total knee replacement: a Bayesian meta-analysis of 23 comparative studies. Int Orthop 35(3):331–339PubMedCentralPubMedCrossRef

Chandrasekaran S, Molnar RB (2008) Minimally invasive imageless computer-navigated knee surgery: initial results. J Arthroplast 23(3):441–445CrossRef

Cheng T, Zhang G, Zhang X (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 171(2):590–600PubMedCrossRef

Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20(7):1307–1322PubMedCrossRef

Chin PL, Foo LS, Yang KY, Yeo SJ, Lo NN (2007) Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplast 22(6):800–806CrossRef

10.

Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplast 20(5):618–626CrossRef

11.

Desai AS, Dramis A, Kendoff D, Board TN (2011) Critical review of the current practice for computer-assisted navigation in total knee replacement surgery: cost-effectiveness and clinical outcome. Curr Rev Musculoskelet Med 4(1):11–15PubMedCentralPubMedCrossRef

12.

Figgie HE III, Goldberg VM, Figgie MP, Inglis AE, Kelly M, Sobel M (1989) The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty. J Bone Jt Surg Am 71(7):1031–1039

13.

Harvie P, Sloan K, Beaver RJ (2012) Computer navigation vs conventional total knee arthroplasty: five-year functional results of a prospective randomized trial. J Arthroplast 27(5):667–672.e1

14.

Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplast 27(6):1177–1182CrossRef

15.

Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplast 26(3):504.e5–504.e8

16.

Huang NF, Dowsey MM, Ee E, Stoney JD, Babazadeh S, Choong PF (2012) Coronal alignment correlates with outcome after total knee arthroplasty: five-year follow-up of a randomized controlled trial. J Arthroplast 27(9):1737–1741CrossRef

17.

Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Jt Surg Br 73(5):709–714

18.

Jung HJ, Jung YB, Song KS, Park SJ, Lee JS (2007) Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Jt Surg Am 89(10):2280–2284CrossRef

19.

Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ (2011) Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplast 26(3):505.e9–505.e11

20.

Li CH, Chen TH, Su YP, Shao PC, Lee KS, Chen WM (2008) Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system. J Arthroplast 23(2):304–307CrossRef

21.

Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24(4):570–578CrossRef

22.

Mader JT, Shirtliff M, Calhoun JH (1997) Staging and staging application in osteomyelitis. Clin Infect Dis 25(6):1303–1309PubMedCrossRef

23.

Marx RG, Grimm P, Lillemoe KA, Robertson CM, Ayeni OR, Lyman S, Bogner EA, Pavlov H (2011) Reliability of lower extremity alignment measurement using radiographs and PACS. Knee Surg Sports Traumatol Arthrosc 19(10):1693–1698PubMedCrossRef

24.

Ossendorf C, Fuchs B, Koch P (2006) Femoral stress fracture after computer navigated total knee arthroplasty. Knee 13(5):397–399PubMedCrossRef

25.

Owens RF Jr, Swank ML (2010) Low incidence of postoperative complications due to pin placement in computer-navigated total knee arthroplasty. J Arthroplast 25(7):1096–1098CrossRef

26.

Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156PubMed

27.

Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Jt Surg Br 85(6):830–835

28.

Tingart M, Lüring C, Bäthis H, Beckmann J, Grifka J, Perlick L (2008) Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine? Knee Surg Sports Traumatol Arthrosc 16(1):44–50PubMedCrossRef

29.

Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43PubMed

30.

Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ (2008) Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplast 23(3):462–465CrossRef

Title: Less outliers in pinless navigation compared with conventional surgery in total knee arthroplasty
Authors: Jerry Yongqiang Chen
Pak Lin Chin
Darren Keng Jin Tay
Shi-Lu Chia
Ngai Nung Lo
Seng Jin Yeo
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2456-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Less outliers in pinless navigation compared with conventional surgery in total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 8/2014

Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia

Can we define envelope of laxity during navigated knee arthroplasty?

Difference in knee rotation between total and unicompartmental knee arthroplasties during stair climbing

Comment on: Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers

The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty

Erratum to: Brake response time returns to the pre-surgical level 6 weeks after unicompartmental knee arthroplasty