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Published in: International Orthopaedics 2/2014

01-02-2014 | Original Paper

Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique

Authors: Alfonso Manzotti, Pietro Cerveri, Chris Pullen, Norberto Confalonieri

Published in: International Orthopaedics | Issue 2/2014

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Abstract

Purpose

The aim of this study was to retrospectively compare the results of two matched-paired groups of patients who had undergone a medial unicompartmental knee arthroplasty (UKA) performed using either a conventional or a non-image-guided navigation technique specifically designed for unicompartmental prosthesis implantation.

Methods

Thirty-one patients with isolated medial-compartment knee arthritis who underwent an isolated navigated UKA were included in the study (group A) and matched with patients who had undergone a conventional medial UKA (group B). The same inclusion criteria were used for both groups. At a minimum of six months, all patients were clinically assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) index. Radiographically, the frontal-femoral-component angle, the frontal-tibial-component angle, the hip-knee-ankle angle and the sagittal orientation of components (slopes) were evaluated. Complications related to the implantation technique, length of hospital stay and surgical time were compared.

Results

At the latest follow-up, no statistically significant differences were seen in the KSS, function scores and WOMAC index between groups. Patients in group B had a statistically significant shorter mean surgical time. Tibial coronal and sagittal alignments were statistically better in the navigated group, with five cases of outliers in the conventional alignment technique group. Postoperative mechanical axis was statistically better aligned in the navigated group, with two cases of overcorrection from varus to valgus in group B. No differences in length of hospital stay or complications related to implantation technique were seen between groups.

Conclusion

This study shows that a specifically designed UKA-dedicated navigation system results in better implant alignment in UKA surgery. Whether this improved alignment results in better clinical results in the long term has yet to be proven.
Literature
1.
go back to reference John J, Kuiper JH, May PC (2009) Age at follow-up and mechanical axis are good predictors of function after unicompartmental knee arthroplasty. An analysis of patients over 17 years follow-up. Acta Orthop Belg 75(1):45–50PubMed John J, Kuiper JH, May PC (2009) Age at follow-up and mechanical axis are good predictors of function after unicompartmental knee arthroplasty. An analysis of patients over 17 years follow-up. Acta Orthop Belg 75(1):45–50PubMed
2.
go back to reference Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–85PubMed Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–85PubMed
3.
go back to reference Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 84:351–5PubMedCrossRef Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 84:351–5PubMedCrossRef
4.
go back to reference Sarangi PP, Karachalios T, Jackson M, Newman JH (1994) Patterns of failed internal unicompartmental knee prostheses, allowing persistence of undercorrection. Rev Chir Orthop Reparatrice Appar Mot 80:217–22PubMed Sarangi PP, Karachalios T, Jackson M, Newman JH (1994) Patterns of failed internal unicompartmental knee prostheses, allowing persistence of undercorrection. Rev Chir Orthop Reparatrice Appar Mot 80:217–22PubMed
5.
go back to reference Voss F, Sheinkop MB, Galante JO, Barden RM, Rosenberg AG (1995) Miller-Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations. J Arthroplasty 10:764–71PubMedCrossRef Voss F, Sheinkop MB, Galante JO, Barden RM, Rosenberg AG (1995) Miller-Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations. J Arthroplasty 10:764–71PubMedCrossRef
6.
go back to reference Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–5PubMedCrossRef Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–5PubMedCrossRef
7.
go back to reference Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86:506–11PubMed Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86:506–11PubMed
8.
go back to reference Kort NP, van Raay JJ, Thomassen BJ (2007) Alignment of the femoral component in a mobile-bearing unicompartmental knee arthroplasty: a study in 10 cadaver femora. Knee 14:280–3PubMedCrossRef Kort NP, van Raay JJ, Thomassen BJ (2007) Alignment of the femoral component in a mobile-bearing unicompartmental knee arthroplasty: a study in 10 cadaver femora. Knee 14:280–3PubMedCrossRef
10.
go back to reference Zamora LA, Humphreys KJ, Watt AM, Forel D, Cameron AL (2013) Systematic review of computer-navigated total knee arthroplasty. ANZ J Surg 83:22–30PubMedCrossRef Zamora LA, Humphreys KJ, Watt AM, Forel D, Cameron AL (2013) Systematic review of computer-navigated total knee arthroplasty. ANZ J Surg 83:22–30PubMedCrossRef
11.
go back to reference Nakano N, Matsumoto T, Ishida K, Tsumura N, Kuroda R, Kurosaka M (2013) Long-term subjective outcomes of computer-assisted total knee arthroplasty. Int Orthop 37:1911–5PubMedCrossRef Nakano N, Matsumoto T, Ishida K, Tsumura N, Kuroda R, Kurosaka M (2013) Long-term subjective outcomes of computer-assisted total knee arthroplasty. Int Orthop 37:1911–5PubMedCrossRef
12.
go back to reference Yaffe M, Chan P, Goyal N, Luo M, Cayo M, Stulberg SD (2013) Computer-assisted versus manual TKA: no difference in clinical or functional outcomes at 5-year follow-up. Orthopedics 36:e627–32PubMedCrossRef Yaffe M, Chan P, Goyal N, Luo M, Cayo M, Stulberg SD (2013) Computer-assisted versus manual TKA: no difference in clinical or functional outcomes at 5-year follow-up. Orthopedics 36:e627–32PubMedCrossRef
13.
go back to reference Jenny JY, Boeri C (2002) Accuracy of implantation of a unicompartmental total knee arthroplasty with 2 different instrumentations: a case-controlled comparative study. J Arthroplasty 17:1016–20PubMedCrossRef Jenny JY, Boeri C (2002) Accuracy of implantation of a unicompartmental total knee arthroplasty with 2 different instrumentations: a case-controlled comparative study. J Arthroplasty 17:1016–20PubMedCrossRef
14.
go back to reference Keene G, Simpson D, Kalairajah Y (2006) Limb alignment in computer-assisted minimally-invasive unicompartmental knee replacement. J Bone Joint Surg Br 88:44–8PubMedCrossRef Keene G, Simpson D, Kalairajah Y (2006) Limb alignment in computer-assisted minimally-invasive unicompartmental knee replacement. J Bone Joint Surg Br 88:44–8PubMedCrossRef
15.
go back to reference Lim MH, Tallay A, Bartlett J (2009) Comparative study of the use of computer assisted navigation system for axial correction in medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:341–6PubMedCrossRef Lim MH, Tallay A, Bartlett J (2009) Comparative study of the use of computer assisted navigation system for axial correction in medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:341–6PubMedCrossRef
16.
go back to reference Perlick L, Bathis H, Tingart M, et al. (2004) Minimally invasive unicompartmental knee replacement with a nonimage-based navigation system 28:193–71 Perlick L, Bathis H, Tingart M, et al. (2004) Minimally invasive unicompartmental knee replacement with a nonimage-based navigation system 28:193–71
17.
go back to reference Weber P, Crispin A, Schmidutz F, Utzschneider S, Pietschmann MF, Jansson V, Müller PE (2013) Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 23. [Epub ahead of print] Weber P, Crispin A, Schmidutz F, Utzschneider S, Pietschmann MF, Jansson V, Müller PE (2013) Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 23. [Epub ahead of print]
18.
go back to reference Valenzuela GA, Jacobson NA, Geist DJ, Valenzuela RG, Teitge RA (2013) Implant and limb alignment outcomes for conventional and navigated unicompartmental knee arthroplasty. J Arthroplasty 28:463–8PubMedCrossRef Valenzuela GA, Jacobson NA, Geist DJ, Valenzuela RG, Teitge RA (2013) Implant and limb alignment outcomes for conventional and navigated unicompartmental knee arthroplasty. J Arthroplasty 28:463–8PubMedCrossRef
19.
go back to reference Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277:7–72 Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277:7–72
20.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN (1998) Rationale of the Knee Society Clinical Rating System. Clin Orthop 248:13–14 Insall JN, Dorr LD, Scott RD, Scott WN (1998) Rationale of the Knee Society Clinical Rating System. Clin Orthop 248:13–14
21.
go back to reference Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and knee. J Rheumatol 15:1833–1840PubMed Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and knee. J Rheumatol 15:1833–1840PubMed
22.
go back to reference Manzotti A, Confalonieri N, Pullen C (2007) Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study. Int Orthop 31:315–9PubMedCentralPubMedCrossRef Manzotti A, Confalonieri N, Pullen C (2007) Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study. Int Orthop 31:315–9PubMedCentralPubMedCrossRef
23.
go back to reference Confalonieri N, Manzotti A, Pullen C (2007) Navigated shorter incision or smaller implant in knee arthritis? Clin Orthop Relat Res 463:63–7PubMed Confalonieri N, Manzotti A, Pullen C (2007) Navigated shorter incision or smaller implant in knee arthritis? Clin Orthop Relat Res 463:63–7PubMed
24.
go back to reference Berger RA, Meneghini RM, Jacobs JJ, Skeinkop MB, Della Valle CJ, Rosenberg AG, Galante JO (2005) Results of unicompartmental knee arthroplasty at a follow-up of ten-years follow-up. J Bone Joint Surg 87A:999–1006CrossRef Berger RA, Meneghini RM, Jacobs JJ, Skeinkop MB, Della Valle CJ, Rosenberg AG, Galante JO (2005) Results of unicompartmental knee arthroplasty at a follow-up of ten-years follow-up. J Bone Joint Surg 87A:999–1006CrossRef
25.
go back to reference Newman JH, Ackroyd CE, Shah NA (2001) Unicompartmental or total knee replacement ? J Bone Joint Surg 80B:862–865 Newman JH, Ackroyd CE, Shah NA (2001) Unicompartmental or total knee replacement ? J Bone Joint Surg 80B:862–865
26.
go back to reference Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 91:52–7PubMedCrossRef Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 91:52–7PubMedCrossRef
27.
go back to reference Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16:473–8PubMedCrossRef Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16:473–8PubMedCrossRef
28.
go back to reference Prime MS, Palmer J, Khan WS (2011) The National Joint Registry of England and Wales. Orthopedics Prime MS, Palmer J, Khan WS (2011) The National Joint Registry of England and Wales. Orthopedics
29.
30.
go back to reference Markel DC, Sutton K (2005) Unicompartmental knee arthroplasty: trouble shooting implant positioning and technical failures. J Knee Surg 18:96–101PubMedCrossRef Markel DC, Sutton K (2005) Unicompartmental knee arthroplasty: trouble shooting implant positioning and technical failures. J Knee Surg 18:96–101PubMedCrossRef
31.
go back to reference Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 83:45–9PubMedCrossRef Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 83:45–9PubMedCrossRef
Metadata
Title
Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique
Authors
Alfonso Manzotti
Pietro Cerveri
Chris Pullen
Norberto Confalonieri
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 2/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2215-8

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