NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

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Ligament balancing in computer-assisted total knee arthroplasty: Improved clinical results with a spring-loaded tensioning device

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/09544119jeim269 ◽

2007 ◽

Vol 221 (7) ◽

pp. 755-761 ◽

Cited By ~ 13

Author(s):

M Swank ◽

J R Romanowski ◽

L L Korbee ◽

S Bignozzi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Results ◽

Computer Assisted ◽

Knee Ligament ◽

Assisted Navigation ◽

Knee Mechanics ◽

Computer Assistance ◽

Significant Difference ◽

Total Knee

Total knee arthroplasty (TKA) remains one of the most successful procedures in orthopaedic surgery. Complications certainly exist and are often related to failure of knee ligament balance. This asymmetry subsequently leads to component mal-alignment and loosening often secondary to deviation of the lower extremity mechanical axis. Understanding knee mechanics is essential, and recent technological advances have begun to minimize postoperative problems. A tensioning device that respects the native patellofemoral anatomy as well as the natural ligamentous strains has been developed. The surgical integration of computer-assisted navigation has allowed for enhanced accuracy and subsequently better results. The purpose of the current paper is to discuss the evolution of an improved ligament tensioning device, in the setting of classic mechanical guidance versus computer assistance and its postoperative impact on total knee outcomes in terms of manipulation rates and two-year radiographic alignment data. Based on a single surgeon series, mechanically guided arthroplasties resulted in a 16 per cent manipulation rate. Computer assistance with spacer blocks decreased the manipulation rate to 14 per cent, while using a novel tensioner device further decreased the manipulation rate to 7 per cent, a significant difference of p <0.01. Radiographic data illustrate all TKAs with the tensioner to be within 4° of the desired position.

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Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara

Journal of Orthopaedic Surgery ◽

10.1177/2309499020905702 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902090570 ◽

Cited By ~ 1

Author(s):

Yongun Cho ◽

Hun-Kyu Shin ◽

Eugene Kim ◽

Jai Hyung Park ◽

Se-Jin Park ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Lower Extremity ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Computer Assisted ◽

Tibia Vara ◽

Assisted Navigation ◽

Significant Difference ◽

Outcome Comparison ◽

Total Knee

Purpose: Total knee arthroplasty (TKA) is the definite treatment for osteoarthritis. Meanwhile, significant inherent extra-articular varus angulation is associated with abnormal postoperative hip–knee–ankle (HKA) angle. Computer-assisted navigation TKA (CAS-TKA) used in patients who have severe varus deformity. The purpose of this study was to compare postoperative radiologic outcome between CAS-TKA and conventional TKA for extra-articular tibia vara. Methods: A retrospective review of postoperative HKA on standing lower extremity views was conducted in patients who underwent TKA by a single surgeon from 2010 to 2018, including knee with conventional TKA ( n = 83) and CAS-TKA ( n = 246). Extra-articular tibia vara was assessed by measuring the metaphyseal–diaphyseal angle (MDA) of the tibia in preoperative standing lower extremity view. Postoperative alignment was assessed by measuring the HKA in postoperative standing lower extremity view. Results: There was no significant difference in age ( p = 0.063), gender ( p = 0.628), body mass index ( p = 0.426), preoperative range of motion ( p = 0.524), preoperative HKA ( p = 0.306), preoperative MDA ( p = 0.523), or postoperative HKA ( p = 0.416) between the two groups (conventional TKA and CAS-TKA). There was no significant difference in postoperative alignment for cases with MDA ≤4° ( p = 0.351) or MDA >4° ( p = 0.866) in each group. There was a positive correlation between preoperative HKA and postoperative HKA in the CAS-TKA group ( p < 0.001, r = 0.243). However, there was no significant correlation between preoperative HKA and postoperative HKA in the conventional TKA group ( p = 0.732). Conclusions: There was no significant difference in postoperative alignment between conventional TKA and CAS-TKA in extra-articular tibial vara even for cases with MDA >4°.

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Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

The Journal of Knee Surgery ◽

10.1055/s-0038-1676372 ◽

2019 ◽

Vol 33 (01) ◽

pp. 034-041 ◽

Cited By ~ 1

Author(s):

Theodore S. Wolfson ◽

David Novikov ◽

Kevin K. Chen ◽

Kelvin Y. Kim ◽

Afshin A. Anoushiravani ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Subgroup Analysis ◽

Blood Management ◽

Folate Supplementation ◽

Level Of Evidence ◽

Significant Difference ◽

Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

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Reliability of Imageless Computer-Assisted Navigation for Femoral Rotational Alignment in Total Knee Arthroplasty

Malaysian Orthopaedic Journal ◽

10.5704/moj.2103.012 ◽

2021 ◽

Vol 15 (1) ◽

pp. 79-84

Author(s):

Leelasestaporn C ◽

Thuwapitchayanant M ◽

Sirithanapipat P ◽

Sa-ngasoongsong P ◽

Ruengsilsuwit P

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rotational Alignment ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee

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Accuracy of femoral rotational alignment in total knee arthroplasty using computer assisted navigation

Computer Aided Surgery ◽

10.3109/10929080802045640 ◽

2008 ◽

Vol 13 (3) ◽

pp. 167-172 ◽

Cited By ~ 18

Author(s):

Camilo Restrepo ◽

William J. Hozack ◽

Fabio Orozco ◽

Javad Parvizi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rotational Alignment ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee

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Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy

ISRN Orthopedics ◽

10.1155/2013/794827 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Tanner C. Clark ◽

Frank H. Schmidt

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Secondary Outcome ◽

Computer Assisted ◽

Robot Assisted ◽

Tourniquet Time ◽

Assisted Navigation ◽

Total Knee ◽

Primary Total Knee

Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was 0.5° less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment.

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