Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty

Abstract

While computer assisted total knee arthroplasty (TKA) has been documented to increase the surgical accuracy in the planning process, there is little information about the accuracy in execution processes. We aimed to determine the accuracy of execution processes for bone resections and implant fixation in TKAs performed with the techniques of computer assisted navigation and minimally invasive surgery. Execution deviations, defined as the differences between planned targets and executed results, were evaluated for bone resections and implant fixation in 107 TKAs. In tibia resection, the mean resection thickness, coronal alignment, and sagittal alignment were 0.2 mm smaller, 0.3° more valgus, 0.3° less posterior slope than the planned, respectively. In femur resection, the mean resection thicknesses in the medial and lateral femoral condyles, coronal alignment, and sagittal alignment were 0.6 mm smaller, 0.8 mm smaller, 0.1° more varus, and 0.7° less posterior slope than the planned, respectively. In implant fixation, the mean coronal alignment and degree of extension was 0.7° more valgus and 1.6° decrease than the planned, respectively. Only the occurrence of unacceptable executions in implant fixation had significant effects on the final coronal alignment. The density of a bone and the quality of saw blade had significant effect on the accuracy of bone resections. Execution deviations from planned alignment commonly occur in computer-assisted minimally invasive TKA, resulting typically from the techniques of bone resections and implant fixation, and this information should be considered to improve the surgical accuracy of navigated TKAs.