Reliable Alignment in Total Knee Arthroplasty by the Use of an IPod-Based Navigation System

Overview

Journal Adv Orthop

Publisher Wiley

Specialty Orthopedics

Date 2016 Jun 18

PMID 27313898

Citations 3

Authors

Paola Koenen

Marco M Schneider

Matthias Frohlich

Arne Driessen

Bertil Bouillon

Holger Bathis

Affiliations

Soon will be listed here.

Abstract

Axial alignment is one of the main objectives in total knee arthroplasty (TKA). Computer-assisted surgery (CAS) is more accurate regarding limb alignment reconstruction compared to the conventional technique. The aim of this study was to analyse the precision of the innovative navigation system DASH® by Brainlab and to evaluate the reliability of intraoperatively acquired data. A retrospective analysis of 40 patients was performed, who underwent CAS TKA using the iPod-based navigation system DASH. Pre- and postoperative axial alignment were measured on standardized radiographs by two independent observers. These data were compared with the navigation data. Furthermore, interobserver reliability was measured. The duration of surgery was monitored. The mean difference between the preoperative mechanical axis by X-ray and the first intraoperatively measured limb axis by the navigation system was 2.4°. The postoperative X-rays showed a mean difference of 1.3° compared to the final navigation measurement. According to radiographic measurements, 88% of arthroplasties had a postoperative limb axis within ±3°. The mean additional time needed for navigation was 5 minutes. We could prove very good precision for the DASH system, which is comparable to established navigation devices with only negligible expenditure of time compared to conventional TKA.

Citing Articles

Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements.

Koenen P, Ates D, Pfeiffer T, Bouillon B, Bathis H Knee Surg Sports Traumatol Arthrosc. 2019; 28(4):1014-1022.

PMID: 31131420 DOI: 10.1007/s00167-019-05548-6.

Current concepts and future perspectives in computer-assisted navigated total knee replacement.

Matsumoto T, Nakano N, Lawrence J, Khanduja V Int Orthop. 2018; 43(6):1337-1343.

PMID: 29752509 DOI: 10.1007/s00264-018-3950-7.

Total knee arthroplasties from the origin to navigation: history, rationale, indications.

Saragaglia D, Rubens-Duval B, Gaillot J, Lateur G, Pailhe R Int Orthop. 2018; 43(3):597-604.

PMID: 29589088 DOI: 10.1007/s00264-018-3913-z.

References

Burnett R, Barrack R . Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review. Clin Orthop Relat Res. 2012; 471(1):264-76. PMC: 3528921. DOI: 10.1007/s11999-012-2528-8. View

Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S . Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res. 2007; 457:156-62. DOI: 10.1097/BLO.0b013e3180316c92. View

Bathis H, Shafizadeh S, Paffrath T, Simanski C, Grifka J, Luring C . [Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies]. Orthopade. 2006; 35(10):1056-65. DOI: 10.1007/s00132-006-1001-3. View

Hoppe S, Mainzer J, Frauchiger L, Ballmer P, Hess R, Zumstein M . More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up. Acta Orthop. 2012; 83(6):629-33. PMC: 3555448. DOI: 10.3109/17453674.2012.747923. View

Cheng T, Zhao S, Peng X, Zhang X . Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?. Knee Surg Sports Traumatol Arthrosc. 2011; 20(7):1307-22. DOI: 10.1007/s00167-011-1588-8. View

Cooke T, Sled E, Scudamore R . Frontal plane knee alignment: a call for standardized measurement. J Rheumatol. 2007; 34(9):1796-801. View

Yau W, Leung A, Chiu K, Tang W, Ng T . Intraobserver errors in obtaining visually selected anatomic landmarks during registration process in nonimage-based navigation-assisted total knee arthroplasty: a cadaveric experiment. J Arthroplasty. 2005; 20(5):591-601. DOI: 10.1016/j.arth.2005.02.011. View

Bellemans J . Neutral mechanical alignment: a requirement for successful TKA: opposes. Orthopedics. 2011; 34(9):e507-9. DOI: 10.3928/01477447-20110714-41. View

Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A . Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007; 89(2):261-9. DOI: 10.2106/JBJS.F.00601. View

10.

Bozic K, Kurtz S, Lau E, Ong K, Chiu V, Vail T . The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2009; 468(1):45-51. PMC: 2795838. DOI: 10.1007/s11999-009-0945-0. View

11.

Tingart M, Luring C, Bathis H, Beckmann J, Grifka J, Perlick L . Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?. Knee Surg Sports Traumatol Arthrosc. 2007; 16(1):44-50. DOI: 10.1007/s00167-007-0399-4. View

12.

Hoffart H, Langenstein E, Vasak N . A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br. 2012; 94(2):194-9. DOI: 10.1302/0301-620X.94B2.27454. View

13.

Mezger U, Jendrewski C, Bartels M . Navigation in surgery. Langenbecks Arch Surg. 2013; 398(4):501-14. PMC: 3627858. DOI: 10.1007/s00423-013-1059-4. View

14.

Dexel J, Kirschner S, Gunther K, Lutzner J . Agreement between radiological and computer navigation measurement of lower limb alignment. Knee Surg Sports Traumatol Arthrosc. 2013; 22(11):2721-7. DOI: 10.1007/s00167-013-2599-4. View

15.

Stulberg S, Loan P, Sarin V . Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am. 2002; 84-A Suppl 2:90-8. View

16.

Longstaff L, Sloan K, Stamp N, Scaddan M, Beaver R . Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2008; 24(4):570-8. DOI: 10.1016/j.arth.2008.03.002. View

17.

Krackow K, Phillips M, Mihalko W . A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA. Orthopedics. 1999; 22(7):698-702. View

18.

Luring C, Kauper M, Bathis H, Perlick L, Beckmann J, Grifka J . A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters. Int Orthop. 2011; 36(3):553-8. PMC: 3291781. DOI: 10.1007/s00264-011-1297-4. View

19.

de Steiger R, Liu Y, Graves S . Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am. 2015; 97(8):635-42. DOI: 10.2106/JBJS.M.01496. View

20.

Yaffe M, Koo S, Stulberg S . Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res. 2008; 466(11):2736-44. PMC: 2565038. DOI: 10.1007/s11999-008-0427-9. View