, Volume 29, Issue 3, pp 253–260 | Cite as

Chirurgia protesica mini-invasiva computer-assistita nell’artrosi di ginocchio in esiti di osteosintesi per fratture di femore

  • Norberto Confalonieri
  • Anna Gambarara
  • Andrea Corriero
  • Alfonso Manzotti

Mini-invasive computer assisted knee replacement in arthosis following femoral fracture


Post-traumatic knee arthrosis can be the result of residual misalignment outcome of the fracture or the result of a direct injury of the articular surface. Hardware presence and bone sclerosis often make impossible the use of intramedullary guides for the correct prosthesis alignment.

Frequently have to be performed additional operations such as hardware removal or corrective osteotomies before implanting the prosthesis, with an increased risk of infection and arthrofibrosis. The weakening of the bone resulting from the hardware removal increases the risk of fracture, while the need of multiple approaches increases the risk of soft tissue sofference.

There are good extramedullary tool kits for tibial cuts, more difficult and less precise the extramedullary tool kit for femoral cuts.

Knee arthroplasty outcomes in post traumatic knee is poor than in primary osteoarthritis. The computer assisted technique allows a better prosthesis alignment, improving outcomes and survival of the implant, eliminating the use of intramedullary guides allows to perform the arthroplasty without previously removing the hardware.

We compared two groups of patients undergoing knee arthroplasty. In group A patients with results of the lower limbs fracture operated with computer assisted technique; in group B patients homogeneous to the first in terms of arthritic alteration suffering from primary osteoarthritis of the knee operated with traditional technique.

Our conclusion is that with the computer assisted surgery is possible to obtain reproducible and comparable results to those that you can get in ’primary osteoarthritis knee replacement, in a single surgical time with a reducing of complications and costs.


Conflitto di interesse

Gli autori Norberto Confalonieri, Anna Gambarara, Andrea Corriero e Alfonso Manzotti dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and animal rights

L’articolo non contiene alcuno studio eseguito su esseri animali da parte degli autori.


  1. 1.
    Papadopoulos EC, Parvizi J, Lai CH, Lewallen DG (2002) Total knee arthroplasty following prior distal femoral fracture. Knee 9(4):267–274 CrossRefPubMedGoogle Scholar
  2. 2.
    Weiss NG, Parvizi J, Hanssen AD et al. (2003) Total knee arthroplasty in post-traumatic arthrosis of the knee. J Arthroplast 18(3 Suppl 1):23–26 CrossRefGoogle Scholar
  3. 3.
    Wu LD, Xiong Y, Yan SG, Yang QS (2005) Total knee replacement for posttraumatic degenerative arthritis of the knee. Chin J Traumatol 8(4):195–199 PubMedGoogle Scholar
  4. 4.
    Brooks DB, Burstein AH, Frankel VH (1970) The biomechanics of torsional fractures. The stress concentration effect of a drill hole. J Bone Jt Surg Am 52(3):507–514 CrossRefGoogle Scholar
  5. 5.
    Johnson BA, Fallat LM (1997) The effect of screw holes on bone strength. J Foot Ankle Surg 36(6):446–451 CrossRefPubMedGoogle Scholar
  6. 6.
    Ries MD (1998) Prophylactic intramedullary femoral rodding during total knee arthroplasty with simultaneous femoral plate removal. J Arthroplast 13(6):718–721 CrossRefGoogle Scholar
  7. 7.
    Baldini A, Adravanti P (2008) Less invasive TKA: extramedullary femoral reference without navigation. Clin Orthop Relat Res 466(11):2694–2700 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Confalonieri N, Manzotti A, Pullen C, Rangone V (2005) Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg 71(6):703–797 PubMedGoogle Scholar
  9. 9.
    Pang CH, Chan WL, Yen CH et al. (2009) Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding system: a prospective study. J Orthop Surg (Hong Kong) 17(2):170–173 CrossRefGoogle Scholar
  10. 10.
    Catani F, Digennaro V, Ensini A et al. (2011) Navigation-assisted total knee arthroplasty in knees with osteoarthritis due to extra-articular deformity. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1602-1 Google Scholar
  11. 11.
    Klein GR, Austin MS, Smith EB, Hozack WJ (2006) Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia. J Arthroplast 21(2):284–288 CrossRefGoogle Scholar
  12. 12.
    Kuo CC, Bosque J, Meehan JP, Jamali AA (2011) Computer-assisted navigation of total knee arthroplasty for osteoarthritis in a patient with severe posttraumatic femoral deformity. J Arthroplast 26(6):976.e17–976.e20 CrossRefGoogle Scholar
  13. 13.
    Martin A, Wohlgenannt O, Prenn M, von Strempel A (2008) Post-traumatic osteoarthritis of the knee: special indication for navigation TKA. Unfallchirurg 111(9):754–758 CrossRefPubMedGoogle Scholar
  14. 14.
    Patai J, Janositz G, Mécs L, Tóth K (2007) Navigated total knee arthroplasty in a patient with severe diaphyseal deformities. Acta Orthop Belg 73(4):536–540 PubMedGoogle Scholar
  15. 15.
    Insall JN, Dorr LD, Scott RD, Scott WN (1998) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14 Google Scholar
  16. 16.
    Bellamy N, Buchanan WW, Goldsmith CH et al. (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and knee. J Rheumatol 15:1833–1840 PubMedGoogle Scholar
  17. 17.
    Kim KK, Heo YM, Won YY, Lee WS (2011) Navigation-assisted total knee arthroplasty for the knee retaining femoral intramedullary nail, and distal femoral plate and screws. Clin Orthop Surg 3(1):77–80 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Norberto Confalonieri
    • 1
  • Anna Gambarara
    • 1
  • Andrea Corriero
    • 1
  • Alfonso Manzotti
    • 1
  1. 1.U.O. di Ortopedia e Traumatologia, Presidio Ospedaliero CTOIstituti Clinici di PerfezionamentoMilanoItalia

Personalised recommendations