Aktueller Stellenwert der Navigation in der Knieendoprothetik in orthopädischen und unfallchirurgischen Kliniken in Deutschland

Zusammenfassung

Studienziel: Bei der fortgeschrittenen Gonarthrose ist die Knie-TEP-Implantation ein Standardverfahren. Die Navigation stellt eine Technik dar, die es ermöglicht, eine genaue Positionierung der Implantate durchzuführen. Ziel unserer bundesweiten Erhebung war es, den aktuellen Stellenwert der Navigation zu erfassen. Methode: 506 orthopädisch/unfallchirurgische Kliniken wurden mit einem anonymen Fragebogen in Bezug auf die Anwendung der Navigation befragt. Ergebnisse: Die Daten von 194 Kliniken konnten erhoben werden und repräsentierten 39 941 knieendoprothetische Eingriffe im Jahr 2008. Diese stellten 35 624 primäre und 4317 Wechseloperationen dar. 29 % der primären endoprothetischen Knie-TEP und 4 bzw. 7 % der Schlittenprothesen/Wechseloperationen wurden navigiert durchgeführt. Die Navigationstechnik wurde von 65 % der Befragten als sinnvoll betrachtet und 77 % sahen eine höhere Präzision durch die Navigation in der Knieendoprothetik als erwiesen an. 31 % der Kliniken berichten über eine minimalinvasive Implantation, wobei 36 % dieser Operationen in navigierter Technik durchgeführt wurden. Schlussfolgerung: Es zeigte sich innerhalb der Kliniken eine zum größten Teil positive Einschätzung der Navigation bei steigenden Operationszahlen. Jedoch ist aufgrund der fehlenden Langzeitergebnisse bei der Navigation eine weitere Beurteilung von diesen abhängig.

Abstract

Aim: Total knee arthroplasty is one of the standard procedures in severe osteoarthritis of the knee. Computer-assisted navigation systems became more popular in the last decade. Navigation systems improve the component positioning and the alignment in total knee arthroplasties. The aim of this survey was to capture the actual trend in computer-assisted total knee arthroplasties in Germany and to discuss the results in comparison to the current literature. Methods: A questionnaire form was sent to 506 orthopaedic and trauma surgery departments in Germany. The first part of the survey included general questions about the department and total knee arthroplasties. The surgeons were asked about their application behaviour and their rating of computer-assisted navigation in total knee arthroplasty in the second part. Questions concerning total knee arthroplasties, unicondylar knee arthroplasties and revision total knee arthroplasties were included in the form. Results: 194 of the departments returned the questionnaire. A total of 39 941 knee arthroplasty surgeries were performed in these departments. 35 624 of these surgeries were primary knee arthroplasties including 32 789 total knee arthroplasties and 2835 unicondylar knee arthroplasties. In addition, 4317 revision total knee arthroplasties were performed by the respondents. 60 % of the departments used a computer-assisted navigation system. In synopsis 29 % of the primary total knee arthroplasties, 4 % of the unicondylar knee arthroplasties and 7 % of the revision knee arthroplasties were performed with a computer-assisted navigation system. Minimal invasive surgery was performed in 31 % of the departments and 36 % of these surgeries were done with navigation-assistance. The “ligament-balanced” procedure was the most common used technique to determine the femur rotation in navigated total knee arthroplasties. In 75 % of navigated total knee arthroplasties cemented components were implanted. Overall 65 % of respondents approved of navigation-assisted surgeries and 77 % saw an improved precision by this technique. The number of computer-assisted navigation uses in surgeries is increasing in 34 % of the departments and decreasing in 13 %. Conclusion: The computer-assisted navigation in total knee arthroplasties is a frequently used technique. The most respondents support the application of navigation-assisted knee arthroplasties and indicate an improved outcome measured by the postoperative alignment. Nevertheless, long-term results are needed for a final evaluation of navigation-assisted surgery.

Knieendoprothetik - Navigation - Umfrage

total knee arthroplasty - computer‐assisted navigation - survey

Literatur

• 1 Bundesgeschäftsstelle für Qualitätssicherung .BQS Qualitätsreport Fachgruppe Orthopädie und Unfallchirurgie. Im Internet: http://www.bqs-qualitaetsindikatoren.de/2008/17n5-KNIE-TEP
• 2 Bundesgeschäftsstelle für Qualitätssicherung .BQS Qualitätsreport Fachgruppe Orthopädie und Unfallchirurgie. Im Internet: http://www.bqs-qualitaetsindikatoren.de/2008/17n7-KNIE-WECH
• 3 Bertsch C, Holz U, Konrad G et al. Early clinical outcome after navigated total knee arthroplasty. Comparison with conventional implantation in TKA: a controlled and prospective analysis.  Orthopade. 2007;  36 739-745
• 4 Brin Y S, Nikolaou V S, Joseph L et al. Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies.  Int Orthop. 2010;  [Epub ahead of print]
• 5 Kamat Y D, Aurakzai K M, Adhikari A R et al. Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?.  Int Orthop. 2009;  33 1567-1570
• 6 Leng C G, Zhao J T, Chen C M et al. Computer-assisted navigation for total knee arthroplasty: a comparative study with conventional methods.  Zhonghua Yi Xue Za Zhi. 2007;  87 3035-3037
• 7 Tingart M, Luring C, Bathis H et al. Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?.  Knee Surg Sports Traumatol Arthrosc. 2008;  16 44-50
• 8 Weng Y J, Hsu R W, Hsu W H. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty.  J Arthroplasty. 2009;  24 668-673
• 9 Callaghan J J, Liu S S, Warth L C. Computer-assisted surgery: a wine before its time: in the affirmative.  J Arthroplasty. 2006;  21 27-28
• 10 Bonutti P M, Dethmers D, Ulrich S D et al. Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks.  Clin Orthop Relat Res. 2008;  466 2756-2762
• 11 Bäthis H, Tingart M, Perlick L et al. Total knee arthroplasty and high tibial osteotomy in osteoarthritis – results of a survey in traumatic surgery and orthopedic clinics.  Z Orthop Ihre Grenzgeb. 2005;  143 19-24
• 12 Lüring C, Tingart M, Beckmann J et al. [Surgical Training in Orthopaedic and Trauma Departments in Germany].  Z Orthop Unfall. 2010;  148 466-470
• 13 Jenny J Y, Miehlke R K, Giurea A. Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres.  Knee. 2008;  15 80-84
• 14 Bathis H, Perlick L, Tingart M et al. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique.  J Bone Joint Surg [Br]. 2004;  86 682-687
• 15 Bathis H, Shafizadeh S, Paffrath T et al. Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies.  Orthopade. 2006;  35 1056-1065
• 16 Lee D H, Park J H, Song D I et al. Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection.  Knee Surg Sports Traumatol Arthrosc. 2010;  18 381-387
• 17 Luring C, Bathis H, Tingart M et al. Computer assistance in total knee replacement – a critical assessment of current health care technology.  Comput Aided Surg. 2006;  11 77-80
• 18 Sharkey P F, Hozack W J, Rothman R H et al. Why are total knee arthroplasties failing today?.  Clin Orthop Relat Res. 2002;  404 7-13
• 19 Graichen H, Strauch M, Katzhammer T et al. Ligament instability in total knee arthroplasty – causal analysis.  Orthopade. 2007;  36 650-656
• 20 Kalairajah Y, Cossey A J, Verrall G M et al. Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomised, clinical trial.  J Bone Joint Surg [Br]. 2006;  88 198-202
• 21 Kalairajah Y, Simpson D, Cossey A J et al. Blood loss after total knee replacement: effects of computer-assisted surgery.  J Bone Joint Surg [Br]. 2006;  88 44-48
• 22 Cerha O, Kirschner S, Günther K P et al. Cost analysis for navigation in knee endoprosthetics.  Orthopade. 2009;  38 1235-1240
• 23 Friederich N, Verdonk R. The use of computer-assisted orthopedic surgery for total knee replacement in daily practice: a survey among ESSKA/SGO-SSO members.  Knee Surg Sports Traumatol Arthrosc. 2008;  16 536-543
• 24 Chotanaphuti T, Ongnamthip P, Teeraleekul K et al. Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study.  J Med Assoc Thai. 2008;  91 1382-1388
• 25 Walde T A, Bussert J, Sehmisch S et al. Optimized functional femoral rotation in navigated total knee arthroplasty considering ligament tension.  Knee. 2010;  [Epub ahead of print]
• 26 Duffy G P, Murray B E, Trousdale R R. Hybrid total knee arthroplasty analysis of component failures at an average of 15 years.  J Arthroplasty. 2007;  22 1112-1115
• 27 Gioe T J, Killeen K K, Grimm K et al. Why are total knee replacements revised?: analysis of early revision in a community knee implant registry.  Clin Orthop Relat Res. 2004;  428 100-106
• 28 Buckup K, Linke L C, Hahne V. Minimally invasive implantation and computer navigation for a unicondylar knee system.  Orthopedics. 2007;  30 66-69
• 29 Jenny J Y. Navigated unicompartmental knee replacement.  Sports Med Arthrosc. 2008;  16 103-107
• 30 Jenny J Y. Unicompartmental knee replacement: a comparison of four techniques combining less invasive approach and navigation.  Orthopedics. 2008;  31 (10 Suppl. 1)
• 31 Jung K A, Kim S J, Lee S C et al. Accuracy of implantation during computer-assisted minimally invasive Oxford unicompartmental knee arthroplasty. A comparison with a conventional instrumented technique.  Knee. 2009;  [Epub ahead of print]
• 32 Marcacci M, Nofrini L, Iacono F et al. A novel computer-assisted surgical technique for revision total knee arthroplasty.  Comput Biol Med. 2007;  37 1771-1779
• 33 Perlick L, Bathis H, Perlick C et al. Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 167-173
• 34 Perlick L, Luring C, Tingart M et al. Revision prosthetic of the knee joint. The influence of a navigation system on the alignment and reconstruction of the joint line.  Orthopade. 2006;  35 1080-1086