An accelerometer-based navigation did not improve the femoral component positioning compared to a modified conventional technique of pre-operatively planned placement of intramedullary rod in total knee arthroplasty

  • Tadashi TsukeokaEmail author
  • Yoshikazu Tsuneizumi
  • Kensuke Yoshino
Knee Arthroplasty



Although the most commonly used method of femoral component alignment in total knee arthroplasty (TKA) is intramedullary (IM) guides, this method demonstrated a limited degree of accuracy. Because of the femoral anterior bowing, the tip of the guide rod will impinge on the anterior cortex if a long rod is inserted. We hypothesized that the pre-operative planned insertion depth of the rod could increase the accuracy of the femoral component positioning in conventional TKA (modified conventional technique). Accelerometer-based, portable navigation device has been postulated to have better accuracy than conventional TKA in component positioning. The purpose of this study was to compare the post-operative femoral component alignment of TKA using the modified conventional technique with the accelerometer-based navigation.

Materials and methods

Fifty-five knees underwent TKA using the modified conventional technique and femoral component positioning was compared with 55 knees performed using the accelerometer-based navigation device. The femoral component alignment was evaluated with a CT-based three-dimensional software.


The mean absolute deviation from targeted alignment in the sagittal plane was significantly less in the modified conventional cohort than in the accelerometer-based navigation cohort (1.1° vs 2.6°, P < 0.001). In the modified conventional cohort, 96.4% had an alignment within 3° of a targeted angle in the coronal plane (vs 89.1% with the accelerometer-based navigation, P = 0.14), and 96.4% in the sagittal plane (vs 74.5% with the accelerometer-based navigation, P < 0.001).


The modified conventional technique is a simple and equal to or more accurate method than the accelerometer-based navigation in positioning the femoral component in TKA at a mid-volume hospital.


Total knee arthroplasty Accelerometer-based navigation Three-dimensional planning Intramedullary rod Insertion depth 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Gilbert BM (1976) Anterior femoral curvature: its probably basis and utility as a criterion of racial assessment. Am J Phys Anthropol 45:6014CrossRefGoogle Scholar
  2. 2.
    Harper MC, Carson WL (1987) Curvature of the femur and the proximal entry point for an intramedullary rod. Clin Orthop 220:155–161Google Scholar
  3. 3.
    Singh SP, Singh S (1972) A study of anterior femoral curvature in Indian subjects. Acta Anat 83:416–425CrossRefGoogle Scholar
  4. 4.
    Trudell MB (1999) Anterior femoral curvature revisited: race assessment from the femur. J Forensic Sci 44:700–707CrossRefGoogle Scholar
  5. 5.
    Tang WM, Chiu KY, Kwan MF, Ng TP, Yau WP (2005) Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty. J Orthop Res 23(1):41–45CrossRefGoogle Scholar
  6. 6.
    Kai S, Sato T, Kog Y, Ariumi A, Tanabe Y, Seitoku N (2008) Accuracy examination for 3-D controlled insertion of intramedullary alignment rod in total knee arthroplasty. Jpn J Clin Biomech 29:285–291Google Scholar
  7. 7.
    Shi X, Li H, Zhou Z, Shen B, Yang J, Pei F (2016) Comparison of postoperative alignment using fixed vs individual valgus correction angle in primary total knee arthroplasty with lateral bowing. FemurJ Arthroplasty 31(5):976–983CrossRefGoogle Scholar
  8. 8.
    Abdelaal AH, Yamamoto N, Hayashi K, Takeuchi A, Morsy AF, Miwa S, Kajino Y, Rubio DA, Tsuchiya H (2016) Radiological assessment of the femoral bowing in Japanese population. SICOT J 2:2CrossRefGoogle Scholar
  9. 9.
    Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin SI (2015) Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc 23(7):1936–1942CrossRefGoogle Scholar
  10. 10.
    Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106CrossRefGoogle Scholar
  11. 11.
    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(7):1307–1322CrossRefGoogle Scholar
  12. 12.
    Mitsuhashi S, Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T (2018) Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component. Arch Orthop Trauma Surg 138(2):259–266CrossRefGoogle Scholar
  13. 13.
    Nam D, Nawabi DH, Cross MB, Heyse TJ, Mayman DJ (2012) Accelerometer-based computer navigation for performing the distal femoral resection in total knee arthroplasty. J Arthroplasty 27(9):1717–1722CrossRefGoogle Scholar
  14. 14.
    Nam D, Weeks KD, Reinhardt KR et al (2013) Accelerometer-based, portable navigation vs imageless, large-console computer-assisted navigation in total knee arthroplasty: a comparison of radiographic results. J Arthroplasty 28(2):255–261CrossRefGoogle Scholar
  15. 15.
    Huang EH, Copp SN, Bugbee WD (2015) Accuracy of a handheld accelerometer-based navigation system for femoral and tibial resection in total knee arthroplasty. J Arthroplasty 30(11):1906–1910CrossRefGoogle Scholar
  16. 16.
    Steinhaus ME, McLawhorn AS, Richardson SS, Maher P, Mayman DJ (2016) Handheld navigation device and patient-specific cutting guides result in similar coronal alignment for primary total knee arthroplasty: a retrospective matched cohort study. HSS J 12(3):224–234CrossRefGoogle Scholar
  17. 17.
    Fujimoto E, Sasashige Y, Nakata K, Yokota G, Omoto T, Ochi M (2017) Technical considerations and accuracy improvement of accelerometer-based portable computer navigation for performing distal femoral resection in total knee arthroplasty. J Arthroplasty 32(1):53–60CrossRefGoogle Scholar
  18. 18.
    Gharaibeh MA, Solayar GN, Harris IA, Chen DB, MacDessi SJ (2017) Accelerometer-based, portable navigation (kneealign) vs conventional instrumentation for total knee arthroplasty: a prospective randomized comparative trial. J Arthroplasty 32(3):777–782CrossRefGoogle Scholar
  19. 19.
    Maderbacher G, Schaumburger J, Baier C, Zeman F, Springorum HR, Birkenbach AM, Grifka J, Keshmiri A (2016) Appropriate sagittal femoral component alignment cannot be ensured by intramedullary alignment rods. Knee Surg Sports Traumatol Arthrosc 24(8):2453–2460CrossRefGoogle Scholar
  20. 20.
    Loh B, Chen JY, Yew AKS, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ (2017) The accuracy of a hand-held navigation system in total knee arthroplasty. Arch Orthop Trauma Surg 137(3):381–386CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tadashi Tsukeoka
    • 1
    Email author
  • Yoshikazu Tsuneizumi
    • 1
  • Kensuke Yoshino
    • 2
  1. 1.Department of Orthopaedic SurgeryChiba Rehabilitation CenterChibaJapan
  2. 2.Department of Orthopaedic SurgeryChiba UniversityChibaJapan

Personalised recommendations