Radiographic Assessment of Total Knee Arthroplasty Alignment With and Without Accelerometer-Based Navigation at a Resident Training Institution

Abstract

Malalignment and lack of surgeon experience are cited as risk factors for prosthetic failure and the need for subsequent revision surgery in total knee arthroplasty (TKA). Various conventional (CON) and computer-assisted surgical (CAS) methods have been developed to try and prevent malalignment and limit outliers. One of these methods is through an accelerometer-based CAS (aCAS), which intraoperatively helps determine the angulation and amount of resection necessary to restore alignment in TKA. The purpose of this study was to determine the number of TKA alignment outliers in TKAs performed both with CON and aCAS methods at a single training institution in cases that trainees were involved in. In this retrospective single-center study, radiographic analysis of 150 primary TKAs performed at our training institution was performed. The medial distal femoral angle (DFA), medial proximal tibial angle (PTA), and posterior slope angle (PSA) were evaluated on immediate postoperative radiographs of 75 aCAS and 75 CON knees. Outlier measurements were defined as DFA outside of 5 ± 3 degrees valgus, PTA > ± 3 degrees from neutral axis, and PSA outside 0 to 7 degrees for cruciate retaining and 0 to 5 degrees for posterior stabilized implants. Data was analyzed using chi-squared, analysis of variance, and Student's t-tests. There was no significant difference found between these two groups in the total number of outliers (8% aCAS vs. 9.8% CON, p = 0.508). Additionally, there was also no significant difference found for any of the radiographic measurements independently; DFA (8% vs. 8%, p = 1.00), PTA (4% vs. 9%, p = 0.184), and PSA (12% vs. 12%, p = 1.00), when comparing aCAS and CON TKAs. Primary TKAs performed at a single training institution demonstrated no significant difference between aCAS and CON methods in the total number of outliers or in the number of outliers for each postoperative radiographic measurement. This study would suggest that there is no advantage in limiting outliers when utilizing aCAS for TKAs at training institutions in cases that trainees are involved in.

Level of Evidence Level III Retrospective Cohort Study

Keywords

total knee arthroplasty - accelerometer - computer-assisted surgery - training institution

Authors' Contributions

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval for the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosures

There were no competing interests in this study or study design. This research received no external funding or competitive funding. No Artificial Intelligence (AI) software or writing tools were used in the research process of this study.

Data Availability Statement

Data is contained within the article.

Publication History

Received: 26 June 2024

Accepted: 21 November 2024

Accepted Manuscript online:
22 November 2024

Article published online:
27 December 2024

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