J Knee Surg 2012; 25(04): 347-352
DOI: 10.1055/s-0031-1299670
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Computer Navigated Versus Conventional Total Knee Arthroplasty

Jaap J. Tolk
1   Máxima Medical Centre, Orthopedic Centre Máxima, Eindhoven, The Netherlands
,
Henk W. J. Koot
1   Máxima Medical Centre, Orthopedic Centre Máxima, Eindhoven, The Netherlands
,
Rob P. A. Janssen
1   Máxima Medical Centre, Orthopedic Centre Máxima, Eindhoven, The Netherlands
› Author Affiliations
Further Information

Publication History

06 September 2011

05 October 2011

Publication Date:
03 May 2012 (online)

Abstract

In total knee arthroplasty (TKA), reconstruction of a neutral mechanical axis is of great importance. The main goal of this study was to compare the accuracy of alignment after conventional versus computer-assisted TKA. Additionally, the effect of computer-assisted surgery (CAS) on functional outcome was analyzed. Out of a consecutive series, 50 conventional TKA were compared with 50 computer-assisted TKA. Except for the use of CAS, all perioperative and postoperative interventions were comparable. Radiological outcome was analyzed on standardized standing long-leg radiographs. Functional outcome was assessed using the Oxford Knee Score (OKS) and the Knee Society Score (KSS). No significant difference in mean mechanical axis alignment between the two groups was found. The number of outliers deviating more than 3 degrees from the mechanical axis was significantly reduced by using CAS, with 50% outliers in the conventional group and 26% outliers in the CAS group (p = 0.023). At mid-term follow-up, the OKS and KSS knee and function scores did not show statistical difference between the two groups. The present study showed a reduction of the number of outliers exceeding 3 degrees from the tibiofemoral mechanical axis using CAS-TKA. This improvement in accuracy did not result in improvement of the functional outcome at mid-term follow-up.

 
  • References

  • 1 Callaghan JJ. Mobile-bearing knee replacement: clinical results: a review of the literature. Clin Orthop Relat Res 2001; 392 (392) 221-225
  • 2 Buechel Sr FF. Long-term followup after mobile-bearing total knee replacement. Clin Orthop Relat Res 2002; 404 (404) 40-50
  • 3 Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007; 22 (8) 1097-1106
  • 4 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (5) 709-714
  • 5 Taylor M, Barrett DS. Explicit finite element simulation of eccentric loading in total knee replacement. Clin Orthop Relat Res 2003; 414 (414) 162-171
  • 6 Berend ME, Ritter MA, Meding JB , et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; 428 (428) 26-34
  • 7 Bauwens K, Matthes G, Wich M , et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89 (2) 261-269
  • 8 Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J. Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop 2011; 35 (3) 331-339
  • 9 Molfetta L, Caldo D. Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee 2008; 15 (2) 75-79
  • 10 Lüring C, Oczipka F, Perlick L, Tingart M, Grifka J, Bäthis H. Two year follow-up comparing computer assisted versus freehand TKR on joint stability, muscular function and patients satisfaction. Knee Surg Sports Traumatol Arthrosc 2009; 17 (3) 228-232
  • 11 Lützner J, Günther KP, Kirschner S. Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2010; 18 (10) 1339-1344
  • 12 Ek ET, Dowsey MM, Tse LF , et al. Comparison of functional and radiological outcomes after computer-assisted versus conventional total knee arthroplasty: a matched-control retrospective study. J Orthop Surg (Hong Kong) 2008; 16 (2) 192-196
  • 13 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (4) 560-569
  • 14 Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 1995; 77 (9) 1331-1334
  • 15 Wright JG, Treble N, Feinstein AR. Measurement of lower limb alignment using long radiographs. J Bone Joint Surg Br 1991; 73 (5) 721-723
  • 16 Luo CF. Reference axes for reconstruction of the knee. Knee 2004; 11 (4) 251-257
  • 17 Haverkamp D, Breugem SJ, Sierevelt IN, Blankevoort L, van Dijk CN. Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty. Acta Orthop 2005; 76 (3) 347-352
  • 18 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; 248 (248) 13-14
  • 19 Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA. Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br 2006; 88 (5) 601-605
  • 20 D’Lima DD, Hermida JC, Chen PC, Colwell Jr CW. Polyethylene wear and variations in knee kinematics. Clin Orthop Relat Res 2001; 392 (392) 124-130
  • 21 Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994; 299 (299) 153-156
  • 22 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6, Suppl) 39-43
  • 23 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
  • 24 Matziolis G, Adam J, Perka C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 2010; 130 (12) 1487-1491
  • 25 Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ. Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 2007; 89 (4) 477-480
  • 26 Seon JK, Park SJ, Lee KB, Li G, Kozanek M, Song EK. Functional comparison of total knee arthroplasty performed with and without a navigation system. Int Orthop 2009; 33 (4) 987-990
  • 27 Benjamin J, Johnson R, Porter S. Knee scores change with length of follow-up after total knee arthroplasty. J Arthroplasty 2003; 18 (7) 867-871
  • 28 Lüring C, Kauper M, Bäthis H , et al. A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters. Int Orthop 2012; 36 (3) 553-558
  • 29 Tingart M, Lüring C, Bäthis H, Beckmann J, Grifka J, Perlick L. Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?. Knee Surg Sports Traumatol Arthrosc 2008; 16 (1) 44-50
  • 30 Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br 2008; 90 (9) 1121-1127
  • 31 Browne JA, Cook C, Hofmann AA, Bolognesi MP. Postoperative morbidity and mortality following total knee arthroplasty with computer navigation. Knee 2010; 17 (2) 152-156
  • 32 Owens Jr RF, Swank ML. Low incidence of postoperative complications due to pin placement in computer-navigated total knee arthroplasty. J Arthroplasty 2010; 25 (7) 1096-1098
  • 33 Jenny JY, Miehlke RK, Giurea A. Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 2008; 15 (2) 80-84
  • 34 Krackow KA, Pepe CL, Galloway EJ. A mathematical analysis of the effect of flexion and rotation on apparent varus/valgus alignment at the knee. Orthopedics 1990; 13 (8) 861-868
  • 35 Brouwer RW, Jakma TS, Brouwer KH, Verhaar JA. Pitfalls in determining knee alignment: a radiographic cadaver study. J Knee Surg 2007; 20 (3) 210-215