Computer-assisted Navigation Total Knee Arthroplasty Research Articles

Артропластика коленного сустава при внесуставных деформациях: какую тактику лечения выбрать? (клиническое наблюдение и обзор литературы)

Background Extraarticular deformity of the femur or tibia may be critical for the success of primary total knee arthroplasty (TKA). Recognizing an extraarticular deformity preoperatively allows a surgeon to choose between various management strategies. The surgical treatment options for correction of an extraarticular deformity include (1) primary TKA, (2) simultaneous corrective osteotomy and TKA and (3) staged corrective osteotomy and delayed TKA. Objective To substantiate differentiated approach to treatment strategies for osteoarthritic knee with extraarticular deformity based on international and our own experience. Material and methods Comparative analysis of current literature on surgical treatment of extraarticular deformities in arthritic knees was produced. The differentiated approach was illustrated by a clinical instance of a 35-year-old patient with bilateral end-stage gonarthrosis associated with extraarticular deformity of both lower limbs. Staged treatment was considered for the congenital multiplanar multilevel deformity in the shaft of the left femur with 26o valgus alignment, procurvatum, external rotation to be corrected with bifocal osteotomy addressing all components of the deformity and stabilized with interlocking intramedullary nail. Standard TKA on the left side was produced a year later with posterior cruciate ligament (PCL) retention. Acquired uniplanar varus deformity of the right femur was corrected using computer-assisted navigation TKA and the PCL substitution at 5 months after the first procedure. Results Knee score improved from 28 to 85 and from 52 to 86 in the left and right sides while functional activity score increased from 42 to 90 and from 52 to 92, respectively, as measured with American Knee Society scoring system (KSS). There is plenty of evidence in the literature that computer-assisted navigation TKA facilitates accurate limb alignment, better flexion angle and improved functional score whereas osteotomies are associated with a higher risk of complications that can result in delayed consolidation or nonunion. Conclusion Differentiated approach can be advocated for correction of an extraarticular deformity of lower limb to be addressed with TKA depending on the magnitude (in degrees), the location of the deformity in relation to the knee joint and relevant patient specific charactreristics, such as age, gender, clinical history. Computer-assisted navigation TKA is practical for mild diaphyseal deformity associated with gonarthritis. Corrective osteotomy can be useful for severe diaphyseal deformity or with the apex localized close to the joint for realignment at the first stage.

Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara

Total knee arthroplasty (TKA) is the definite treatment for osteoarthritis. Meanwhile, significant inherent extra-articular varus angulation is associated with abnormal postoperative hip-knee-ankle (HKA) angle. Computer-assisted navigation TKA (CAS-TKA) used in patients who have severe varus deformity. The purpose of this study was to compare postoperative radiologic outcome between CAS-TKA and conventional TKA for extra-articular tibia vara. A retrospective review of postoperative HKA on standing lower extremity views was conducted in patients who underwent TKA by a single surgeon from 2010 to 2018, including knee with conventional TKA (n = 83) and CAS-TKA (n = 246). Extra-articular tibia vara was assessed by measuring the metaphyseal-diaphyseal angle (MDA) of the tibia in preoperative standing lower extremity view. Postoperative alignment was assessed by measuring the HKA in postoperative standing lower extremity view. There was no significant difference in age (p = 0.063), gender (p = 0.628), body mass index (p = 0.426), preoperative range of motion (p = 0.524), preoperative HKA (p = 0.306), preoperative MDA (p = 0.523), or postoperative HKA (p = 0.416) between the two groups (conventional TKA and CAS-TKA). There was no significant difference in postoperative alignment for cases with MDA ≤4° (p = 0.351) or MDA >4° (p = 0.866) in each group. There was a positive correlation between preoperative HKA and postoperative HKA in the CAS-TKA group (p < 0.001, r = 0.243). However, there was no significant correlation between preoperative HKA and postoperative HKA in the conventional TKA group (p = 0.732). There was no significant difference in postoperative alignment between conventional TKA and CAS-TKA in extra-articular tibial vara even for cases with MDA >4°.

Tranexamic Acid Reduces Total Blood Loss and Inflammatory Response in Computer-Assisted Navigation Total Knee Arthroplasty.

Introduction Tranexamic acid (TXA) is an effective blood salvage agent that reduces perioperative blood loss in conventional total knee arthroplasty (TKA). As computer-assisted surgery for TKA (CAS-TKA) results in a lower perioperative blood loss than conventional TKA, the additional effect of blood conservation by TXA might be mitigated. This study aimed to evaluate the efficacy of TXA in CAS-TKA. Methods We retrospectively reviewed 222 consecutive patients who underwent CAS-TKA. Intravenous TXA was administered in 103 patients (TXA group) at a dosage of 20 mg/kg 15 min before deflation of the tourniquet. The other 119 patients did not receive TXA (control group). Patient demographic data including age, gender, BMI, DM, and hypertension were collected. The primary outcomes were the estimated total blood loss (ETBL) and perioperative data, including tourniquet duration, preoperative and postoperative day 1 (POD1) and day 3 (POD3) serum D-dimer, CRP, hemoglobin (Hb), and hematocrit (Hct) levels. Secondary outcomes including transfusion rate and 90-day complications were recorded. Results The ETBL was lower in the TXA group on both POD1 (404.34 ± 234.77 vs. 595.47 ± 279.04, p < 0.001) and POD3 (761.39 ± 260.88 vs. 987.79 ± 326.58, p < 0.001). The TXA group also demonstrated a lower level of CRP on POD1 (p=0.02) and lower levels of CRP and serum D-dimer on POD3 (p=0.008 and p < 0.001). Consumption of fibrinogen was higher in the control group on both POD1 (p=0.013) and POD3 (p < 0.001). Length of hospital stay was lower in the TXA group (5.42 ± 1.21 vs. 6.25 ± 1.49, p < 0.001). The transfusion rate and perioperative complications were not significantly different between the two groups. Conclusion Administration of TXA is not only effective in reducing perioperative blood loss and length of hospital stay but also exerts an anti-inflammatory effect following CAS-TKA without causing major complications.

Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery

BackgroundComputer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated. MethodsThis study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants. ResultsStanding lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P<0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P<0.01). ConclusionsIn summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA.

One-stage femoral osteotomy and computer-assisted navigation total knee arthroplasty for osteoarthritis in a patient with femoral subtrochanteric fracture malunion.

Extra-articular femoral deformity in total knee arthroplasty (TKA) is realigned by either intra-articular correction or extra-articular osteotomy. The more distant the deformity is away from knee joint, the more likely it is corrected by the former method. No report described the use of antegrade cephalomedullary femoral nail to fix the osteotomy followed by computer-assisted navigation TKA. This report described the unusual use of this method to manage a 64-year-old man with femoral subtrochanteric fracture malunion and osteoarthritis of knee. He demonstrated a satisfactory functional outcome and good lower limb alignment.

Computer-Assisted Navigation—Total Knee Arthroplasty

Computer-assisted total knee arthroplasty (TKA) has been implemented to improve the accuracy of implant positioning and limb alignment. Studies have shown several benefits of computer-assisted TKA over conventional TKA. However, the technology is not without potential pitfalls. The following article is a technique guide for the use of computer-assisted navigation for TKA.

A comparison of the mechanieal axis and alignment of component between conventional total knee arthroplasty and total knee arthroplasty under computer-assisted navigation

Objective To compare the mechanical axis and alignment of component between conventional total knee arthroplasty(TKA)and TKA under computer-assistde navigation.Methods From May 2007 to December 2009.60 patients with knee osteoarthritis were assigned randomly to receive conventional TKA and computer-assisted navigation TKA with the same type of implant for each knee.In navigation group (group A).there were 11 men and 19 women.with an average age of 69.2±8.3 years.The mean prcoperative alignment deviation was 9.4° ±5.3°.The knee osteoarthritis was rated as grade Ⅲ in 12 cases and grade Ⅳ in 18 cases.In conventional group (group B)、there were 17 men and 13 women,with an average age of 71.9 ± 8.1 years The mean preoperative alignment deviation was 8.9°± 4.8°.The knee osteoarthritis was rated as grade Ⅲ in 17 cases and grade Ⅳ in 13 cases.Alignment of the leg and orientation of components were evaluated on standard pre-and post-operative full-length weight-bearing radiographs and lateral X-rays with reard to the valgus angle and the coronal and sagittal component angles. Results The mean deviation in hip-knee-ankle angle in group A (0.7°±0.2°) was signifieantly smaller than that in group B (1.2°± 0.3°) ( t =3.972.P =0.000).The mean postoperativc deviation in frontal femoral component anglein group A (1.5°±0.4°)was significantly smaller than that in groupB (2.1° ±0.5°) (t=2.433、P =0.017).The mean deviation in frontal tibial component angle in group A (2.1°±0.5°) was insignificantly smaller than that in group B (1.5°±0.6°) (t=0.326.P=0.116).The mean deviations in lateral femoral component and lateral al tibial component angles in group A (7.3°±0.4° and 2.5°±0.2°) were signifi cantly smaller than those in group B (9.5°± 0.4° and 4.5 ± 0.6°) ( P ＜ 0.05 ).The operating time in group A was 15 to 28 minutes longer than in group B(t=2.553,P=0.008).Conclusion Computer-assisted navigation system used in TKA can result in a better correction of alignment of the leg and better orientation of the components than does conventional TKA. Key words: Surgery, computer-assisted; Arthroplasty, replaeement, knee; Prospective studies

Total knee arthroplasty using navigation system for severe osteoarthritis with extra-articular deformity

The purpose of this study was to evaluate the use of total knee arthroplasty (TKA) using a computer-assisted navigation system for treating osteoarthritis with extra-articular deformity. Between January 2006 and January 2009, computer-assisted navigation TKAs were performed on eight knees in eight patients, who had severe osteoarthritis with an ipsilateral extra-articular deformity. All patients were followed up for a minimum of 24months. The involved knees were evaluated by function scores, Knee Society knee scores, and analyzing knee flexion before the operation and at the latest follow-up. Postoperatively, the function scores, Knee Society knee scores, and knee flexion all improved significantly. The ideal mechanical axis of the lower extremity was obtained in all cases. TKA using a computer-assisted navigation system might provide an efficient treatment for patients with osteoarthritis in combination with an extra-articular deformity.

Assessing Short-Term Functional Outcomes and Knee Alignment of Computer-Assisted Navigated Total Knee Arthroplasty

This retrospective study examined the relationship between the mechanical axis of the knee throughout its functional arc and functional outcomes in patients with computer-assisted navigation total knee arthroplasty. Data on final intraoperative functional arc alignment were obtained on 76 patients who had computer-assisted navigation total knee arthroplasty over a 2-year period and correlated with scores from postoperative Short Form 12 and Western Ontario and McMaster Universities functional outcome surveys. No correlation was found between functional arc alignment and outcomes from Western Ontario and McMaster Universities or Short Form 12 surveys; however, subgroup analysis of patients with more than 3° average final intraoperative alignment throughout the functional arc of motion demonstrated increased difficulty with daily activities ( P = .05). The results indicate that patients with more than 3° average alignment throughout the functional arc of motion perform more poorly with daily activities postoperatively.

Osteoporosis affects component positioning in computer navigation-assisted total knee arthroplasty

Although computer-assisted navigation in total knee arthroplasty (TKA) has many advantages, undetected tracker pin movement can result in poor lower limb alignment and component position. Osteoporosis may be an underlying cause of tracker pin movement. The present prospective case–control study compared 6-month radiographic outcomes in 44 osteoporotic and 56 non-osteoporotic knees undergoing navigation TKAs. Osteoporotic knees were defined as those having a T-score of −2.5 or less either in the femoral neck or lumbar spine or both. At postoperative 6months' follow-up, the average coronal tibial component position was greater valgus in osteoporotic group than in nonosteoporotic group (non-osteoporotic=varus 0.7°±1.8°; osteoporotic=valgus 1.2°±3.4°; p=0.041). Multiple linear regression analysis showed that being in the osteoporotic group was a predictor of tibial coronal component position (β=0.321, p=0.039). In addition, preoperative lumbar spine bone mineral density was found to be a predictor of coronal and sagittal alignments of the tibial component (β=0.406, p=0.015, β=−0.463, p=0.007). The present study found that osteoporosis affected tibial component position in computer-assisted navigation TKA. Clinicians should be particularly aware of the possibility of undetectable tracker pin movement during navigation TKA in osteoporotic knees.

Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2 = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.