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Joint line changes after primary total knee arthroplasty: navigated versus non-navigated

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

Abstract

Purpose

Navigation has been introduced to achieve more accurate positioning of the implants after TKA. The scientific attention was mainly paid on limb alignment rather than restoration of the natural joint line. The aim of our study was to compare the accuracy of the joint line restoration in primary TKA with and without navigation. We hypothesized that joint line reconstruction in navigated TKA is more accurate.

Methods

A total of 493 primary TKAs operated in a single medical centre were consecutively selected and divided into two groups. 206 cases were performed computer assisted (BrainLab CI-System), whereas 287 knees were implanted conventionally. For both groups, the joint line position of the knee was determined on standardized calibrated standing pre- and postoperative digital radiographs in ap view by a modified method of Kawamura et al. A joint line shift of more than 8 mm was defined as outlier.

Results

In the conventional group, the joint line shift averaged 0.7 mm (±4.4 mm), whereas the findings in the computer-assisted cases were in average 0.6 mm (±4.5 mm). The joint line was located above 8 mm in 6 % of non-navigated versus 6.8 % of navigated primary TKAs. There were no statistically significant differences of joint line shift between the different component types. A statistically significant relation was not found between joint line shift and leg alignment changes.

Conclusions

Conventional surgical technique allows a precise joint line reconstruction in primary TKA. Navigation did not improve the joint line reconstruction.

Level of evidence

Diagnostic study, Level III.

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Notes

  1. Platform: Ci Navigation Station Software: 2004–2005: Ci Knee 1.1.1 Producer: BrainLAB, Kapellenstr. 12, 2005–2011: Ci Knee 1.1.2 85622 Feldkirchen, Germany.

  2. DePuy Orthopaedics, Inc, 700 Orthopaedic Derive, Warsaw.

  3. Siemens AG, Henkestr. 127, D-91052 Erlangen, Germany.

References

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

    Article  PubMed  Google Scholar 

  2. Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PF (2011) Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Joint Surg Br 93(9):1223–1231

    PubMed  CAS  Google Scholar 

  3. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86(5):682–687

    Article  PubMed  CAS  Google Scholar 

  4. Belvedere C, Ensini A, Leardini A, Bianchi L, Catani F, Giannini S (2007) Alignment of resection planes in total knee replacement obtained with the conventional technique, as assessed by a modern computer-based navigation system. Int J Med Robot 3(2):117–124

    Article  PubMed  CAS  Google Scholar 

  5. Catani F, Biasca N, Ensini A, Leardini A, Bianchi L, Digennaro V, Giannini S (2008) Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty. J Bone Joint Surg Am 90(4):765–771

    Article  PubMed  Google Scholar 

  6. Chao EY, Neluheni EV, Hsu RW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25(3):379–386

    PubMed  CAS  Google Scholar 

  7. Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM (2004) Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 86(6):818–823

    Article  PubMed  CAS  Google Scholar 

  8. 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):1307–1322

    Article  PubMed  Google Scholar 

  9. 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 

  10. Chiu KY, Ng TP, Tang WM, Yau WP (2002) Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong) 10(2):194–202

    CAS  Google Scholar 

  11. Cope MR, O’Brien BS, Nanu AM (2002) The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study. J Arthroplasty 17(2):206–208

    Article  PubMed  CAS  Google Scholar 

  12. Daubresse F, Vajeu C, Loquet J (2005) Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital. Acta Orthop Belg 71(6):710–713

    PubMed  Google Scholar 

  13. 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 

  14. Ensini A, Catani F, Biasca N, Belvedere C, Giannini S, Leardini A (2012) Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(3):495–502

    Article  PubMed  CAS  Google Scholar 

  15. Fickert S, Jawhar A, Sunil P, Scharf HP (2012) Precision of Ci-navigated extension and flexion gap balancing in total knee arthroplasty and analysis of potential predictive variables. Arch Orthop Trauma Surg 132(4):565–574

    Article  PubMed  CAS  Google Scholar 

  16. Figgie HE III, Goldberg VM, Heiple KG, Moller HS III, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68(7):1035–1040

    PubMed  Google Scholar 

  17. Grelsamer RP (2002) Patella baja after total knee arthroplasty: is it really patella baja? J Arthroplasty 17(1):66–69

    Article  PubMed  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. Hart R, Janecek M, Chaker A, Bucek P (2003) Total knee arthroplasty implanted with and without kinematic navigation. Int Orthop 27(6):366–369

    Article  PubMed  CAS  Google Scholar 

  20. Jenny JY, Boeri C (2001) Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation. Rev Chir Orthop Reparatrice Appar Mot 87(7):645–652

    PubMed  CAS  Google Scholar 

  21. 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 

  22. Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ (2009) Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17(3):286–292

    Article  PubMed  Google Scholar 

  23. Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6(3):248–252

    Article  PubMed  CAS  Google Scholar 

  24. Konig C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28(1):1–5

    PubMed  Google Scholar 

  25. Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19(12):2027–2032

    Article  PubMed  Google Scholar 

  26. Martin JW, Whiteside LA (1990) The influence of joint line-position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156

    PubMed  Google Scholar 

  27. Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A (2007) Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty 22(7):953–959

    Article  PubMed  Google Scholar 

  28. Mullaji A, Shetty GM (2009) Computer-assisted TKA: greater precision, doubtful clinical efficacy: opposes. Orthopedics 32(9):679

    Article  Google Scholar 

  29. Pang HN, Yeo SJ, Chong HC, Chin PL, Chia SL, Lo NN (2013) Joint line changes and outcomes in constrained versus unconstrained total knee arthroplasty for the type II valgus knee. Knee Surg Sports Traumatol Arthrosc. Doi: 10.1007/s00167-013-2390-6

  30. Parratte S, Pagnano MW, Trousdale RT, Berry DJ Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Arthroplasty 92 (12):2143–2149

  31. Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171

    Article  PubMed  Google Scholar 

  32. 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 

  33. Ritter MA, Montgomery TJ, Zhou HL, Keating ME, Faris PM, Meding JB (1999) The clinical significance of proximal tibial resection level in total knee arthroplasty. Clin Orthop Relat Res 360:174–181

    Article  PubMed  Google Scholar 

  34. Ryu J, Saito S, Yamamoto K, Sano S (1993) Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 53(3):35–40

    PubMed  CAS  Google Scholar 

  35. Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplasty 24(7):1099–1102

    Article  PubMed  Google Scholar 

  36. Shoji H, Solomonow M, Yoshino S, Dambrosia R, Dabezies E (1990) Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 13(6):643–649

    PubMed  CAS  Google Scholar 

  37. Singerman R, Heiple KG, Davy DT, Goldberg VM (1995) Effect of tibial component position on patellar strain following total knee arthroplasty. J Arthroplasty 10(5):651–656

    Article  PubMed  CAS  Google Scholar 

  38. Snider MG, MacDonald SJ (2009) The influence of the posterior cruciate ligament and component design on joint line position after primary total knee arthroplasty. J Arthroplasty 24(7):1093–1098

    Article  PubMed  Google Scholar 

  39. 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 

  40. Tigani D, Sabbioni G, Ben Ayad R, Filanti M, Rani N, Del Piccolo N (2010) Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique. Knee Surg Sports Traumatol Arthrosc 18(10):1304–1310

    Article  PubMed  Google Scholar 

  41. Victor J, Hoste D (2004) Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res 428:131–139

    Article  PubMed  Google Scholar 

  42. Wyss TF, Schuster AJ, Munger P, Pfluger D, Wehrli U (2006) Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line? Arch Orthop Trauma Surg 126(7):480–486

    Article  PubMed  CAS  Google Scholar 

  43. Yang JH, Seo JG, Moon YW, Kim MH (2009) Joint line changes after navigation-assisted mobile-bearing TKA. Orthopedics 32(10):35–39

    Article  PubMed  Google Scholar 

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Conflict of interest

We authors declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Orthopaedic and Trauma Surgery Center, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    A. Jawhar & H. P. Scharf

  2. Navrang Hospital, Vadodara, Gujarat, India

    V. Shah

  3. Kaushalya Medical Foundation Trust Hospital, Thane, Maharashtra, India

    S. Sohoni

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  1. A. Jawhar
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  2. V. Shah
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  3. S. Sohoni
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  4. H. P. Scharf
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Correspondence to A. Jawhar.

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Jawhar, A., Shah, V., Sohoni, S. et al. Joint line changes after primary total knee arthroplasty: navigated versus non-navigated. Knee Surg Sports Traumatol Arthrosc 21, 2355–2362 (2013). https://doi.org/10.1007/s00167-013-2580-2

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  • DOI: https://doi.org/10.1007/s00167-013-2580-2

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