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No difference in accuracy between pinless and conventional computer-assisted surgery in total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Many studies have demonstrated higher precision and better radiological results in Total knee arthroplasty (TKA) with computer-assisted surgery (CAS). On the other hand, studies revealed a lengthening of operation time up to 20 min for this technique and demonstrated rare additional complications as fractures and neurovascular injuries caused by the array pins and any intraoperative array dislocation leads to abortion of CAS. To combine the advantages and eliminate the disadvantages of standard CAS, we evaluated the accuracy of a so-called pinless CT-free version of knee navigation (pinless CAS) abandoning the reference pins and reducing the necessary workflow to a minimum.

Method

The present study compares the accuracy of the reference methods of two different CT-free knee navigation software versions (Brainlab Knee 2.1 and Brainlab Knee Express 2.5). Thirty patients received TKA assisted by standard CAS. Intraoperatively, the proposed bony resections of standard CAS were matched with the new pinless CAS. Postoperatively, the results were checked by evaluating the radiographs concerning leg axis, femoral flexion and tibial slope.

Results

All results concerning precise cuts (femoral as well as tibial coronal/varus–valgus alignment, femoral flexion alignment and tibial slope, resection height) were comparable between both groups (n.s.). In femoral, we found a mean deviation of coronal alignment of 0.3° (SD 0.7) and flexion of 0.2° (SD 0.8). In tibial, we found a mean deviation of coronal alignment of 0.2° (SD 0.5) and slope of 0.2° (SD 0.6). The mean additional operation time for the pinless CAS was below 2 min. The postoperative mechanical leg axis was within the threshold of 3° in all patients, tibial slope and femoral flexion matched with CAS values.

Conclusion

In clinical routine, pinless CAS can comprise the advantages of CAS leaving the disadvantages aside. It reduces surgical time and avoids complications associated with the tracking pins of conventional CAS.

Level of evidence

I.

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References

  1. Aunan E, Kibsgård T, Clarke-Jenssen J, Röhrl SM (2012) A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees. Arch Orthop Trauma Surg 132:1173–1181

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89:261–269

    Article  PubMed  Google Scholar 

  3. Beldame J, Boisrenoult P, Beaufils P (2010) Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res 96:249–255

    Article  CAS  PubMed  Google Scholar 

  4. Bonutti P, Dethmers D, Stiehl JB (2008) Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 466:1499–1502

    Article  PubMed Central  PubMed  Google Scholar 

  5. Cheng T, Zhao S, Peng X, Zhang X (2012) 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 20:1307–1322

    Article  PubMed  Google Scholar 

  6. Czurda T, Fennema P, Baumgartner M, Ritschl P (2010) The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 18:863–869

    Article  PubMed  Google Scholar 

  7. Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43

    Article  PubMed  Google Scholar 

  8. Fitz W, Sodha S, Reichmann W, Minas T (2012) Does a modified gap-balancing technique result in medial-pivot knee kinematics in cruciate-retaining total knee arthroplasty? A pilot study. Clin Orthop Relat Res 470:91–98

    Article  PubMed Central  PubMed  Google Scholar 

  9. Frantz DD, Wiles AD, Leis SE, Kirsch SR (2003) Accuracy assessment protocols for electromagnetic tracking systems. Phys Med Biol 48:2241–2251

    Article  CAS  PubMed  Google Scholar 

  10. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785

    Article  PubMed  Google Scholar 

  11. Lee D-H, Park J-H, Song D-I, Padhy D, Jeong W-K, Han S-B (2010) Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc 18:381–387

    Article  CAS  PubMed  Google Scholar 

  12. Lopomo N, Sun L, Zaffagnini S, Giordano G, Safran MR (2010) Evaluation of formal methods in hip joint center assessment: an in vitro analysis. Clin Biomech (Bristol, Avon) 25:206–212

    Google Scholar 

  13. Lützner J, Krummenauer F, Wolf C, Günther K-P, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90:1039–1044

    Article  PubMed  Google Scholar 

  14. Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA (2006) Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br 88:601–605

    Article  CAS  PubMed  Google Scholar 

  15. Ranawat CS, Rose HA, Rich DS (1984) Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. Instr Course Lect 33:412–416

    CAS  PubMed  Google Scholar 

  16. Shrout P, Fleiss J (1979) Intraclass correlations: uses in assessing rater reliability

  17. **e C, Liu K, **ao L, Tang R (2012) Clinical outcomes after computer-assisted versus conventional total knee arthroplasty. Orthopedics 35:e647–e653

    Article  PubMed  Google Scholar 

  18. Yau WP, Leung A, Liu KG, Yan CH, Wong LLS, Chiu KY (2007) Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty. J Arthroplasty 22:1150–1161

    Article  CAS  PubMed  Google Scholar 

  19. Zhang G, Chen J, Chai W, Liu M, Wang Y (2011) Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures: a randomized clinical trial. J Bone Joint Surg Am 93:1190–1196

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Mrs Anne Maria Birkenbach for her support and great convenience and work throughout the study.

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Authors and Affiliations

  1. Orthopaedic Department, University of Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany

    C. Baier, G. Maderbacher, H. R. Springorum, J. Schaumburger, J. Grifka & J. Beckmann

  2. Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany

    F. Zeman

  3. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    W. Fitz

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  1. C. Baier
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  2. G. Maderbacher
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Correspondence to C. Baier.

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Baier, C., Maderbacher, G., Springorum, H.R. et al. No difference in accuracy between pinless and conventional computer-assisted surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22, 1819–1826 (2014). https://doi.org/10.1007/s00167-013-2430-2

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  • DOI: https://doi.org/10.1007/s00167-013-2430-2

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