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Navigated intraoperative analysis of lower limb alignment

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Abstract

Introduction: Accurate intraoperative assessment of lower limb alignment is crucial for the treatment of long bone fractures, implantation of knee arthroplasties and correction of deformities. During orthopaedic surgery, exact real time control of the mechanical axis is strongly desirable. The aim of this study was to compare conventional intraoperative analysis of the mechanical axis by the cable method with continuous, 3-dimensional imaging with a navigation system. Materials and methods: Twenty legs of fresh human cadaver were randomly assigned to conventional analysis with the cable method (n=10) or navigated analysis with a fluoroscopy based navigation system (n=10). The intersection of the mechanical axis with the tibia plateau was presented as percentage of the tibia plateau (beginning with 0% at the medial border and ending with 100% laterally). CT-scans were performed for all legs and the CT-values of the mechanical axis were compared to the measurements after cable method and navigation. Furthermore, the radiation time and dose area product of both groups for single analysis of the mechanical axis was compared. Results: Conventional evaluation of the mechanical axis by the cable method showed 6.0±3.1% difference compared to the analysis by CT. In the navigated group the difference was 2.6±1.8% (P=0.008). Radiation time and dose area product were highly significantly lower after conventional measurement. Conclusions: Navigated intraoperative evaluation of the mechanical axis offers increased accuracy compared to conventional intraoperative analysis. Furthermore, navigation provides continuous control not only of the mechanical axis, but also of the sagittal and transverse plane. Using the cable method, radiation exposure depends on the number of measurements and is lower compared to the navigation system for single intraoperative analysis of the mechanical axis, but may be higher in case of repeated intraoperative measurements.

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Authors and Affiliations

  1. Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Stefan Hankemeier, Tobias Hufner, Daniel Kendoff, Martinus Richter, Thomas Gosling & Christian Krettek

  2. Maurice E. Müller Research Center, Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland

    Gongli Wang, Guoyan Zheng & Lutz Nolte

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  1. Stefan Hankemeier
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  2. Tobias Hufner
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  3. Gongli Wang
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  4. Daniel Kendoff
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  5. Guoyan Zheng
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  6. Martinus Richter
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  7. Thomas Gosling
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  8. Lutz Nolte
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  9. Christian Krettek
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Correspondence to Stefan Hankemeier.

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Hankemeier, S., Hufner, T., Wang, G. et al. Navigated intraoperative analysis of lower limb alignment. Arch Orthop Trauma Surg 125, 531–535 (2005). https://doi.org/10.1007/s00402-005-0038-9

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  • DOI: https://doi.org/10.1007/s00402-005-0038-9

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