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Navigation of Alignment and Balancing During Knee Replacement

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Computer Assisted Orthopaedic Surgery for Hip and Knee

Abstract

Neutral mechanical alignment is currently considered the “gold standard” and primary aim of every total knee replacement (TKR). It can be achieved via various surgical techniques, such as with extramedullary and intramedullary guides, patient-specific instrumentation, and navigation, each with advantages and disadvantages. Between 1998 and 2003, we compared three alignment systems in 115 TKRs: the Orthopilot navigation system in 38 patients (group A), totally intramedullary alignment system in 40 patients (group B), and totally extramedullary alignment system in 37 patients (group C). At the 12-month postoperative follow-up, the mean hip–knee–ankle angle (HKA) was 179.1° (range 176°–184°) for group A, 178.6° (173°–186°) for group B, and 177.8° (172°–186°) for group C. Differences among the three groups were not statistically significant. The number of prostheses aligned within 2° of an ideal HKA (180°) in the three groups was 33 (86.8%) in group A, 33 (82.5%) in group B, and 23 (62.1%) in group C. There was a statistically significant difference between groups A and C (A > C) (p = 0.02). Thus, the accuracy of the implant’s alignment was significantly improved by using a navigation system compared with alignment using an extramedullary guide. In the navigation group (A), there were no cases of malalignment of >3° away from an ideal implant alignment in either the frontal or sagittal plane. Navigation has proved to be a useful tool for achieving a more accurate postoperative mechanical axis via precise, reproducible bone resection and ligament balancing. Navigation for TKR has been reported to provide more precise component placement in coronal, sagittal, and rotational alignments, more accurate bone cuts, and better restoration of coronal limb alignment.

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References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89-A:780–5.

    Google Scholar 

  2. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.

    Article  Google Scholar 

  3. Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics. 2012;35:e160–9.

    PubMed  Google Scholar 

  4. Blakeney WG, Khan RJ, Wall SJ. Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93:1377–84.

    Article  Google Scholar 

  5. Tingart M, Lüring C, Bäthis 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.

    Article  Google Scholar 

  6. Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res. 1985;192:13–22.

    Google Scholar 

  7. Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am. 2010;92:2143–9.

    Article  Google Scholar 

  8. Berend ME, Ritter MA, Meding JB, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;428:26–34.

    Article  Google Scholar 

  9. Ritter MA, Davis KE, Meding JB, et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am. 2011;7(93):1588–96.

    Article  Google Scholar 

  10. Collier MB, Engh CA Jr, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am. 2007;89:1306–14.

    Article  Google Scholar 

  11. Fahmy NR, Chandler HP, Danylchuk K, et al. Blood-gas and circulatory changes during total knee replacement. Role of the intramedullary alignment rod. J Bone Joint Surg Am. 1990;72:19–26.

    Article  CAS  Google Scholar 

  12. Huijbregts HJ, Khan RJ, Sorensen E, et al. Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty. Acta Orthop. 2016;1:1–9.

    Google Scholar 

  13. Nunley RM, Ellison BS, Zhu J, et al. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res. 2012;470:895–902.

    Article  Google Scholar 

  14. Pitto RP, Graydon AJ, Bradley L, et al. Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br. 2004;88:601–5.

    Google Scholar 

  15. Rosenberger RE, Hoser C, Quirbach S, et al. Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2007;16:249–57.

    Article  Google Scholar 

  16. Scuderi GR, Fallaha M, Masse V, et al. Total knee arthroplasty with a novel navigation system within the surgical field. Orthop Clin North Am. 2014;45:167–73.

    Article  Google Scholar 

  17. Stöckl B, Nogler M, Rosiek R, et al. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426:180–6.

    Article  Google Scholar 

  18. Mason JB, Fehring TK, Estok R, et al. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplast. 2007;22:1097–106.

    Article  Google Scholar 

  19. Bonner TJ, Eardley WG, Patterson P, Gregg PJ. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br. 2011;93:1217–22.

    Article  CAS  Google Scholar 

  20. Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplast. 2009;24:560–9.

    Article  Google Scholar 

  21. Magnussen RA, Weppe F, Demey G, et al. Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res. 2011;469:3443–50.

    Article  Google Scholar 

  22. Bäthis 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;86:682–7.

    Article  Google Scholar 

  23. Manjunath KS, Gopalakrishna KG, Vineeth G. Evaluation of alignment in total knee arthroplasty: a prospective study. Eur J Orthop Surg Traumatol. 2015;25:895–903.

    Article  CAS  Google Scholar 

  24. Matziolis G, Krocker D, Weiss U, et al. A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am. 2007;89:236–43.

    Article  Google Scholar 

  25. Mielke RK, Clemens U, Jens JH, Kershally S. Navigation in knee endoprosthesis implantation—preliminary experiences and prospective comparative study with conventional implantation technique. Z Orthop Ihre Grenzgeb. 2011;139:109–16.

    Article  Google Scholar 

  26. Petersen TL, Engh GA. Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplast. 1988;3:67–72.

    Article  CAS  Google Scholar 

  27. Mahaluxmivala J, Bankes MJ, Nicolai P, et al. The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplast. 2001;16:635–40.

    Article  CAS  Google Scholar 

  28. Oswald MH, Jakob RP, Schneider E, Hoogewoud HM. Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplast. 1993;8:419–26.

    Article  CAS  Google Scholar 

  29. Reed MR, Bliss W, Sher JL, et al. Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br. 2002;84:858–60.

    Article  CAS  Google Scholar 

  30. Sparmann M, Wolke B, Czupalla H, et al. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br. 2003;85:830–5.

    Article  CAS  Google Scholar 

  31. Decking R, Markmann Y, Fuchs J, et al. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplast. 2005;20:282–8.

    Article  Google Scholar 

  32. Fehring TK, Mason JB, Moskal J, et al. When computer-assisted knee replacement is the best alternative. Clin Orthop Relat Res. 2006;452:132–6.

    Article  Google Scholar 

  33. Jenny JY, Clemens U, Kohler S, et al. Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplast. 2005;20:832–9.

    Article  Google Scholar 

  34. Kim YH, Park JW, Kim JS. Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am. 2012;94:2017–24.

    Article  Google Scholar 

  35. Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplast. 2009;24:668–73.

    Article  Google Scholar 

  36. Fu Y, Wang M, Liu Y, Fu Q. Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012;20:1075–82.

    Article  Google Scholar 

  37. Hetaimish BM, Khan MM, Simunovic N, et al. Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplast. 2012;27:1177–82.

    Article  Google Scholar 

  38. Rebal BA, Babatunde OM, Lee JH, et al. Imageless computer navigation in total knee arthroplasty provides superior short term functional outcomes: a meta-analysis. J Arthroplast. 2014;29:938–44.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. 1st Orthop Department, CTO Hospital, Milan, Italy

    Norberto Confalonieri & Alessio Biazzo

  2. Orthop Department, “Luigi Sacco” Hospital, Milan, Italy

    Alfonso Manzotti

Authors
  1. Norberto Confalonieri
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  2. Alessio Biazzo
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  3. Alfonso Manzotti
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Corresponding author

Correspondence to Norberto Confalonieri .

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Editors and Affiliations

  1. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Nobuhiko Sugano

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Confalonieri, N., Biazzo, A., Manzotti, A. (2018). Navigation of Alignment and Balancing During Knee Replacement. In: Sugano, N. (eds) Computer Assisted Orthopaedic Surgery for Hip and Knee. Springer, Singapore. https://doi.org/10.1007/978-981-10-5245-3_1

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  • DOI: https://doi.org/10.1007/978-981-10-5245-3_1

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-5244-6

  • Online ISBN: 978-981-10-5245-3

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