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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2014

01-03-2014 | Knee

Navigated total knee arthroplasty: is it error-free?

Authors: Kerk Hsiang Zackary Chua, Yongsheng Chen, Krishna Lingaraj

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2014

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Abstract

Purpose

The aim of this study was to determine whether errors do occur in navigated total knee arthroplasty (TKAs) and to study whether errors in bone resection or implantation contribute to these errors.

Methods

A series of 20 TKAs was studied using computer navigation. The coronal and sagittal alignments of the femoral and tibial cutting guides, the coronal and sagittal alignments of the final tibial implant and the coronal alignment of the final femoral implant were compared with that of the respective bone resections. To determine the post-implantation mechanical alignment of the limb, the coronal alignment of the femoral and tibial implants was combined.

Results

The median deviation between the femoral cutting guide and bone resection was 0° (range −0.5° to +0.5°) in the coronal plane and 1.0° (range −2.0° to +1.0°) in the sagittal plane. The median deviation between the tibial cutting guide and bone resection was 0.5° (range −1.0° to +1.5°) in the coronal plane and 1.0° (range −1.0° to +3.5°) in the sagittal plane. The median deviation between the femoral bone resection and the final implant was 0.25° (range −2.0° to 3.0°) in the coronal plane. The median deviation between the tibial bone resection and the final implant was 0.75° (range −3.0° to +1.5°) in the coronal plane and 1.75° (range −4.0° to +2.0°) in the sagittal plane. The median post-implantation mechanical alignment of the limb was 0.25° (range −3.0° to +2.0°).

Conclusions

When navigation is used only to guide the positioning of the cutting jig, errors may arise in the manual, non-navigated steps of the procedure. Our study showed increased cutting errors in the sagittal plane for both the femur and the tibia, and following implantation, the greatest error was seen in the sagittal alignment of the tibial component. Computer navigation should be used not only to guide the positioning of the cutting jig, but also to check the bone resection and implant position during TKA.

Level of evidence

IV.
Literature
1.
Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138PubMedCrossRef
2.
Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86(5):682–687PubMedCrossRef
3.
Bathis H, Perlick L, Tingart M, Perlick C, Luring C, Grifka J (2005) Intraoperative cutting errors in total knee arthroplasty. Arch Orthop Trauma Surg 125(1):16–20PubMedCrossRef
4.
Biant LC, Yeoh K, Walker PM, Bruce WJ, Walsh WR (2008) The accuracy of bone resections made during computer navigated total knee replacement. Do we resect what the computer plans we resect? Knee 15(3):238–241PubMedCrossRef
5.
Bolognesi M, Hofmann A (2005) Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 440:162–169PubMedCrossRef
6.
Bove JC (2010) Computer-assisted total knee arthroplasty: does the tibial component remain at malposition risk? Orthop Traumatol Surg Res 96(5):536–542PubMedCrossRef
7.
Catani F, Biasca N, Ensini A, Leardini A, Bianchi L, Digennaro V, Giannini S (2008) Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty. J Bone Joint Surg Am 90(4):765–771PubMedCrossRef
8.
Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM (2004) Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 86(6):818–823PubMedCrossRef
9.
Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique: a randomised, prospective trial. J Bone Joint Surg Br 86(3):372–377PubMedCrossRef
10.
Dalury DF, Dennis DA (2005) Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77–81PubMedCrossRef
11.
Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S (2007) Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 457:156–162PubMed
12.
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318PubMedCrossRef
13.
Fu Y, Wang M, Liu Y, Fu Q (2012) Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(6):1075–1082PubMedCrossRef
14.
Hasegawa M, Yoshida K, Wakabayashi H, Sudo A (2013) Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system. Int Orthop 37(1):27–30PubMedCentralPubMedCrossRef
15.
16.
Hufner T, Kendoff D, Citak M, Geerling J, Krettek C (2006) Precision in orthopaedic computer navigation. Orthopade 35(10):1043–1055PubMedCrossRef
17.
Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20(7):832–839PubMedCrossRef
18.
Kim TK, Chang CB, Kang YG, Chung BJ, Cho HJ, Seong SC (2010) Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty. Knee 17(1):23–28PubMedCrossRef
19.
Koyonos L, Stulberg SD, Moen TC, Bart G, Granieri M (2009) Sources of error in total knee arthroplasty. Orthopedics 32(5):317PubMedCrossRef
20.
Laskin RS, Beksac B (2006) Computer-assisted navigation in TKA: where we are and where we are going. Clin Orthop Relat Res 452:127–131PubMedCrossRef
21.
Lewold S, Knutson K, Lidgren L (1993) Reduced failure rate in knee prosthetic surgery with improved implantation technique. Clin Orthop Relat Res 287:94–97PubMed
22.
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 Arthroplasty 24(4):570–578PubMedCrossRef
23.
Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59(1):77–79PubMed
24.
Manzotti A, Cerveri P, De Momi E, Pullen C, Confalonieri N (2010) Relationship between cutting errors and learning curve in computer-assisted total knee replacement. Int Orthop 34(5):655–662PubMedCentralPubMedCrossRef
25.
Nakahara H, Matsuda S, Moro-oka TA, Okazaki K, Tashiro Y, Iwamoto Y (2012) Cutting error of the distal femur in total knee arthroplasty by use of a navigation system. J Arthroplasty 27(6):1119–1122PubMedCrossRef
26.
Otani T, Whiteside LA, White SE (1993) Cutting errors in preparation of femoral components in total knee arthroplasty. J Arthroplasty 8(5):503–510PubMedCrossRef
27.
Plaskos C, Hodgson AJ, Inkpen K, McGraw RW (2002) Bone cutting errors in total knee arthroplasty. J Arthroplasty 17(6):698–705PubMedCrossRef
28.
Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93(17):1588–1596PubMedCrossRef
29.
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRef
30.
Slover JD, Tosteson AN, Bozic KJ, Rubash HE, Malchau H (2008) Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am 90(7):1492–1500PubMedCrossRef
31.
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 Joint Surg Br 85(6):830–835PubMed
32.
Yau WP, Chiu KY (2008) Cutting errors in total knee replacement: assessment by computer assisted surgery. Knee Surg Sports Traumatol Arthrosc 16(7):670–673PubMedCrossRef
Metadata
Title
Navigated total knee arthroplasty: is it error-free?
Authors
Kerk Hsiang Zackary Chua
Yongsheng Chen
Krishna Lingaraj
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2641-6

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