Navigation of Alignment and Balancing During Knee Replacement

  • Norberto Confalonieri
  • Alessio Biazzo
  • Alfonso Manzotti


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.


Computer-assisted navigation Total knee replacement Knee balancing Mechanical alignment 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Norberto Confalonieri
    • 1
  • Alessio Biazzo
    • 1
  • Alfonso Manzotti
    • 2
  1. 1.1st Orthop DepartmentCTO HospitalMilanItaly
  2. 2.Orthop Department“Luigi Sacco” HospitalMilanItaly

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