Abstract
Background
Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation.
Questions/Purposes
We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens.
Methods
Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT.
Results
For the synthetic specimens, femoral coronal alignment was within ± 2° of neutral in 94% of the specimens. Sagittal alignment was within 0° to 5° of flexion in all specimens. Rotation was within ± 1° of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned.
Conclusions
TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve.
Clinical Relevance
NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.
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Acknowledgments
Implants and instruments for this study were donated or loaned by DePuy Orthopaedics Inc and Exactech Inc. The authors thank the following surgeons for kindly acting as the subjects, performing the mock surgeries in the study (shown here in alphabetical order and unrelated in any way to any order shown for the results, which were deliberately kept secret): Jack Farr, MD; Pat Kirk, MD; Craig R. Mahoney, MD; Sandeep Munjal, MD; Amar Ranawat, MD; Chit Ranawat, MD; and Steve Teeny, MD.
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The institution of four authors (KLG, AB, CWH, HH) has received, during the study period, funding from DePuy Orthopaedics Inc (Warsaw, IN, USA) and contract research funding from Arthrex Inc (Naples, FL, USA), Biomet Inc (Warsaw, IN, USA), Naval Health Research Center (San Diego, CA, USA), Empirical Testing Corp (Colorado Springs, CO, USA), Exactech Inc (Gainesville, FL, USA), Exponent Inc (Philadelphia, PA, USA), ESKA (Lübeck, Germany), Gruppo Bioimpianti (Milan, Italy), Kyocera Medical Corp (Osaka, Japan), Implanet (Martillac, France), Ortho Development (Draper, UT, USA), Otis Glebe Medical Research Foundation (Omaha, NE, USA), Renovis Surgical Technologies (Redlands, CA, USA), Smith & Nephew Inc (Memphis, TN, USA), SoftJoint (Iowa City, IA, USA), Stryker Orthopaedics (Mahwah, NJ, USA), Spine Medica (Atlanta, GA, USA), and Tornier (Montbonnot, France). The institution of one of the authors (CRM) has received, during the study period, funding from Smith & Nephew. One of the authors (KLG) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $100,001 to $1,000,000 from Biomet Inc. One of the authors (HH) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $10,000 to $100,000 from AMTI (Watertown, MA, USA), an amount of less than $10,000 from Arthrex, an amount of $10,000 to $100,000 from Biomet Inc, an amount of less than $10,000 from Orthopedic Surgical Manufacturers Association (Rockville, MD, USA), an amount of less than $10,000 from SoftJoint, and an amount of less than $10,000 from SI-BONE (San Jose, CA, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at the Orthopaedics Biomechanics & Advanced Surgical Technologies Laboratory, University of Nebraska Medical Center, Omaha, NE, USA.
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Garvin, K.L., Barrera, A., Mahoney, C.R. et al. Total Knee Arthroplasty With a Computer-navigated Saw: A Pilot Study. Clin Orthop Relat Res 471, 155–161 (2013). https://doi.org/10.1007/s11999-012-2521-2
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DOI: https://doi.org/10.1007/s11999-012-2521-2