Skip to main content

Advertisement

Log in

Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?

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

Abstract

Restoration of the mechanical leg axis and component positioning are crucial factors affecting long-term results in total knee arthroplasty (TKA). In a prospective study, 1,000 patients were operated on either using a CT-free navigation system or the conventional jig-based technique. Leg alignment and component orientation were determined on postoperative X-rays. The mechanical leg axis was significantly better in the computer-assisted group (95%, within ±3° varus/valgus) compared to the conventional group (74%, within ±3° varus/valgus) (P < 0.001). On average, the operating time was increased by 8 min in the computer-assisted group. No significant differences were seen between senior and younger surgeons regarding postoperative leg alignment and operating time. Computer-assisted TKA leads to a more accurate restoration of leg alignment and component orientation compared to the conventional jig-based technique. Potential benefits in long-term outcome and functional improvement require further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Laskin RS (2001) The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 388:95–102

    Article  PubMed  Google Scholar 

  2. Rodriguez JA, Bhende H, Ranawat CS (2001) Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 388:10–17

    Article  PubMed  Google Scholar 

  3. Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70(8):1163–1173

    PubMed  CAS  Google Scholar 

  4. Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish Knee Arthroplasty Register 1975–1997: an update with special emphasis on 41,223 knees operated on in 1988–1997. Acta Orthop Scand 72(5):503–513

    Article  PubMed  CAS  Google Scholar 

  5. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714

    PubMed  CAS  Google Scholar 

  6. Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173

    PubMed  Google Scholar 

  7. Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156

    PubMed  Google Scholar 

  8. Petersen TL, Engh GA (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 3(1):67–72

    Article  PubMed  CAS  Google Scholar 

  9. Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty 16(5):635–640

    Article  PubMed  CAS  Google Scholar 

  10. Mielke RK, Clemens U, Jens JH, Kershally S (2001) Navigation in knee endoprosthesis implantation—preliminary experiences and prospective comparative study with conventional implantation technique. Z Orthop Ihre Grenzgeb 139(2):109–116

    Article  PubMed  CAS  Google Scholar 

  11. Bathis H, Perlick L, Tingart M, Luring C, Grifka J (2004) CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. Orthopedics 27(5):476–480

    PubMed  Google Scholar 

  12. Perlick L, Bathis H, Tingart M, Perlick C, Grifka J (2004) Navigation in total-knee arthroplasty: CT-based implantation compared with the conventional technique. Acta Orthop Scand 75(4):464–470

    Article  PubMed  Google Scholar 

  13. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case–control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20(7):832–839

    Article  PubMed  Google Scholar 

  14. Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183

    PubMed  Google Scholar 

  15. Hood RW, Vanni M, Insall JN (1981) The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop Relat Res 160:94–105

    PubMed  Google Scholar 

  16. Hvid I, Nielsen S (1984) Total condylar knee arthroplasty. Prosthetic component positioning and radiolucent lines. Acta Orthop Scand 55(2):160–165

    PubMed  CAS  Google Scholar 

  17. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85(6):830–835

    PubMed  CAS  Google Scholar 

  18. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  19. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20(3):282–288

    Article  PubMed  Google Scholar 

  20. Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 207(Suppl 3):132–138

    Article  Google Scholar 

  21. Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20(5):618–626

    Article  PubMed  Google Scholar 

  22. Kim SJ, MacDonald M, Hernandez J, Wixson RL (2005) Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty 207(Suppl 3):123–131

    Article  Google Scholar 

  23. Bolognesi M, Hofmann A (2005) Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 440:162–169

    Article  PubMed  Google Scholar 

  24. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186

    Article  PubMed  Google Scholar 

  25. Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86(3):372–377

    Article  PubMed  CAS  Google Scholar 

  26. Delp SL, Stulberg SD, Davies B, Picard F, Leitner F (1998) Computer assisted knee replacement. Clin Orthop Relat Res 354:49–56

    Article  PubMed  Google Scholar 

  27. Novotny J, Gonzalez MH, Amirouche FM, Li YC (2001) Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty. J Arthroplasty 16(5):641–647

    Article  PubMed  CAS  Google Scholar 

  28. Reed SC, Gollish J (1997) The accuracy of femoral intramedullary guides in total knee arthroplasty. J Arthroplasty 12(6):677–682

    Article  PubMed  CAS  Google Scholar 

  29. Laskin RS (2003) New techniques and concepts in total knee replacement. Clin Orthop Relat Res 416:151–153

    Article  PubMed  Google Scholar 

  30. Plaskos C, Hodgson AJ, Inkpen K, McGraw RW (2002) Bone cutting errors in total knee arthroplasty. J Arthroplasty 17(6):698–705

    Article  PubMed  Google Scholar 

  31. Bathis H, Perlick L, Tingart M, Perlick C, Luring C, Grifka J (2005) Intraoperative cutting errors in total knee arthroplasty. Arch Orthop Trauma Surg 125(1):16–20

    Article  PubMed  CAS  Google Scholar 

  32. Patel DV, Ferris BD, Aichroth PM (1991) Radiological study of alignment after total knee replacement. Short radiographs or long radiographs? Int Orthop 15(3):209–210

    PubMed  CAS  Google Scholar 

  33. Bathis H, Shafizadeh S, Paffrath T, Simanski C, Grifka J, Luring C (2006) Are computer assisted total knee replacements more accurately placed?: A meta-analysis of comparative studies. Orthopade 35(10):1056–1065

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We wish to acknowledge the work of Stefan Zeidler and Jochen Wolfsteiner in analysing the radiographs. The study complies with the current laws of the country in which they were performed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Markus Tingart.

Additional information

Markus Tingart, Christian Lüring and Holger Bäthis contributed equally to this paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tingart, M., Lüring, C., Bäthis, H. et al. Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?. Knee Surg Sports Traumatol Arthr 16, 44–50 (2008). https://doi.org/10.1007/s00167-007-0399-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-007-0399-4

Keywords

Navigation