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Computer-assisted navigation is beneficial both in primary and revision surgery with modular rotating-hinge knee arthroplasty

  • Björn G. Ochs
  • Anna J. Schreiner
  • Peter M. de Zwart
  • Ulrich Stöckle
  • Christoph Emanuel GonserEmail author
Knee

Abstract

Purpose

The objective of the present study was to explore the effect of navigation on the reconstruction of the mechanical leg axis, implant positioning and the restoration of the joint line in hinged knee arthroplasty in vivo. We present the first 1- to 3-year clinical and radiological results following computer-navigated implantation of the EnduRo modular rotating-hinge knee arthroplasty system (Aesculap AG, Tuttlingen, Germany) as a primary or revision implant.

Methods

Thirty-one patients were analysed retrospectively. Indication was revision surgery in 18 patients and complex primary surgery in 13. The clinical and radiological results of 31 patients with a minimum follow-up of 12 months (mean 22.2 ± 6.2 months) were recorded. Age at follow-up was 55.2 ± 9.9 years.

Results

The absolute varus-valgus deviation from the neutral mechanical leg axis was determined at 5.1° ± 5.1° preoperatively and 2.1° ± 1.4° postoperatively. No intraoperative complications or problems with the navigation system were observed. At latest follow-up, no component loosening was detected. Based on the Knee Society Score, a knee score of 64.9 ± 17.7 points and a function score of 67.2 ± 27.3 points were achieved.

Conclusions

Encouraging short-term clinical and radiological results with the computer-navigated implantation of the modular rotating-hinge EnduRo knee arthroplasty system were found in both primary and revision surgery. The navigation facilitated the reconstruction of the leg axis, implant positioning and the restoration of the joint line.

Level of evidence

IV.

Keywords

Knee replacement Revision knee arthroplasty Computer-assisted surgery Navigation Rotating-hinge knee EnduRo 

Notes

Conflict of interest

No competing interests declared.

References

  1. 1.
    Amanatullah DF, Di Cesare PE, Meere PA, Pereira GC (2013) Identification of the landmark registration safe zones during total knee arthroplasty using an imageless navigation system. J Arthroplast 28(6):938–942CrossRefGoogle Scholar
  2. 2.
    Appleton P, Moran M, Houshian S, Robinson CM (2006) Distal femoral fractures treated by hinged total knee replacement in elderly patients. J Bone Joint Surg Br 88(8):1065–1070PubMedCrossRefGoogle Scholar
  3. 3.
    Baek SW, Choi CH (2011) Management of severe tibial bony defects with double metal blocks in knee arthroplasty—a technical note involving 9 cases. Acta Orthop 82(1):116–118PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Baker P, Critchley R, Gray A, Jameson S, Gregg P, Port A, Deehan D (2014) Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery. Knee Surg Sports Traumatol Arthrosc 22(3):599–608PubMedCrossRefGoogle Scholar
  5. 5.
    Beckmann J, Luring C, Springorum R, Kock FX, Grifka J, Tingart M (2011) Fixation of revision TKA: a review of the literature. Knee Surg Sports Traumatol Arthrosc 19(6):872–879PubMedCrossRefGoogle Scholar
  6. 6.
    Bejek Z, Solyom L, Szendroi M (2007) Experiences with computer navigated total knee arthroplasty. Int Orthop 31(5):617–622PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Bistolfi A, Massazza G, Rosso F, Crova M (2012) Rotating-hinge total knee for revision total knee arthroplasty. Orthopedics 35(3):e325–e330PubMedGoogle Scholar
  8. 8.
    Bolognesi M, Hofmann A (2005) Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 440:162–169PubMedCrossRefGoogle Scholar
  9. 9.
    Burnett RS, Barrack RL (2013) Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review. Clin Orthop Relat Res 471(1):264–276PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    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):1307–1322PubMedCrossRefGoogle Scholar
  11. 11.
    Confalonieri N, Manzotti A, Chemello C, Cerveri P (2010) Computer-assisted revision of failed unicompartmental knee arthroplasty. Orthopedics 33(10 Suppl):52–57PubMedCrossRefGoogle Scholar
  12. 12.
    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):495–502PubMedCrossRefGoogle Scholar
  13. 13.
    Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMedGoogle Scholar
  14. 14.
    Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH (2002) Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res 404:158–168PubMedCrossRefGoogle Scholar
  15. 15.
    Graham DJ, Harvie P, Sloan K, Beaver RJ (2011) Morbidity of navigated vs conventional total knee arthroplasty: a retrospective review of 327 cases. J Arthroplast 26(8):1224–1227CrossRefGoogle Scholar
  16. 16.
    Guenoun B, Latargez L, Freslon M, Defossez G, Salas N, Gayet LE (2009) Complications following rotating hinge Endo-Modell (Link) knee arthroplasty. Orthop Traumatol Surg Res 95(7):529–536PubMedCrossRefGoogle Scholar
  17. 17.
    Gulhane S, Holloway I, Bartlett M (2013) A vascular complication in computer navigated total knee arthroplasty. Indian J Orthop 47(1):98–100PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Harvie P, Sloan K, Beaver RJ (2012) Computer navigation vs conventional total knee arthroplasty: five-year functional results of a prospective randomized trial. J Arthroplast 27(5):667–672.e1CrossRefGoogle Scholar
  19. 19.
    Hernandez-Vaquero D, Sandoval-Garcia MA (2010) Hinged total knee arthroplasty in the presence of ligamentous deficiency. Clin Orthop Relat Res 468(5):1248–1253PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  21. 21.
    Jawhar A, Shah V, Sohoni S, Scharf HP (2013) Joint line changes after primary total knee arthroplasty: navigated versus non-navigated. Knee Surg Sports Traumatol Arthrosc 21(10):2355–2362PubMedCrossRefGoogle Scholar
  22. 22.
    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 Arthroplast 20(7):832–839CrossRefGoogle Scholar
  23. 23.
    Jenny JY, Diesinger Y (2010) Navigated revision TKR: a comparative study with conventional instruments. Orthopedics 33(10 Suppl):58–61PubMedCrossRefGoogle Scholar
  24. 24.
    Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE (2009) Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop 33(6):1567–1570PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Kim SH, Lee HJ, Jung HJ, Lee JS, Kim KS (2013) Less femoral lift-off and better femoral alignment in TKA using computer-assisted surgery. Knee Surg Sports Traumatol Arthrosc 21(10):2255–2262PubMedCrossRefGoogle Scholar
  26. 26.
    Kim YH, Park JW, Kim JS (2012) Computer-navigated versus conventional total knee arthroplasty a prospective randomized trial. J Bone Joint Surg Am 94(22):2017–2024PubMedCrossRefGoogle Scholar
  27. 27.
    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):1–5PubMedGoogle Scholar
  28. 28.
    Laskin RS (1998) Management of the patella during revision total knee replacement arthroplasty. Orthop Clin N Am 29(2):355–360CrossRefGoogle Scholar
  29. 29.
    Lutzner J, Dexel J, Kirschner S (2013) No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 21(10):2241–2247PubMedCrossRefGoogle Scholar
  30. 30.
    Lutzner J, Hubel U, Kirschner S, Gunther KP, Krummenauer F (2011) Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome. Chirurg 82(7):618–624PubMedCrossRefGoogle Scholar
  31. 31.
    Massin P, Boyer P, Pernin J, Jeanrot C (2008) Navigated revision knee arthroplasty using a system designed for primary surgery. Comput Aided Surg 13(4):179–187PubMedCrossRefGoogle Scholar
  32. 32.
    Meijer MF, Stevens M, Boerboom AL, Bulstra SK, Reininga IH (2014) The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty. BMC Musculoskelet Disord 15:94PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Molfetta L, Caldo D (2008) Computer navigation versus conventional implantation for varus knee total arthroplasty: a case–control study at 5 years follow-up. Knee 15(2):75–79PubMedCrossRefGoogle Scholar
  34. 34.
    Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 19(9):1496–1503PubMedCrossRefGoogle Scholar
  35. 35.
    Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, Gavras M (2004) Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up. J Bone Joint Surg Br 86(6):813–817PubMedCrossRefGoogle Scholar
  36. 36.
    Porteous AJ, Hassaballa MA, Newman JH (2008) Does the joint line matter in revision total knee replacement? J Bone Joint Surg Br 90(7):879–884PubMedCrossRefGoogle Scholar
  37. 37.
    Rath B, Springorum HR, Beckmann J, Schaumburger J, Tingart M, Grifka J, Luring C (2011) Importance of computer-assisted navigation in total knee arthroplasty—results of a nationwide survey in Germany. Z Orthop Unfall 149(2):173–177PubMedGoogle Scholar
  38. 38.
    Romero J, Seifert B, Reinhardt O, Ziegler O, Kessler O (2010) A useful radiologic method for preoperative joint-line determination in revision total knee arthroplasty. Clin Orthop Relat Res 468(5):1279–1283PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96PubMedCrossRefGoogle Scholar
  40. 40.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRefGoogle Scholar
  41. 41.
    Smith TH, Gad BV, Klika AK, Styron JF, Joyce TA, Barsoum WK (2013) Comparison of mechanical and nonmechanical failure rates associated with rotating hinged total knee arthroplasty in nontumor patients. J Arthroplast 28(1):62–67.e1CrossRefGoogle Scholar
  42. 42.
    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):830–835PubMedGoogle Scholar
  43. 43.
    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 426:180–186PubMedCrossRefGoogle Scholar
  44. 44.
    Thielemann FW, Clemens U, Hadjicostas PT (2007) Computer-assisted surgery in revision total knee arthroplasty: early experience with 46 patients. Orthopedics 30(10 Suppl):S132–S135PubMedGoogle Scholar
  45. 45.
    Whaley AL, Trousdale RT, Rand JA, Hanssen AD (2003) Cemented long-stem revision total knee arthroplasty. J Arthroplast 18(5):592–599CrossRefGoogle Scholar
  46. 46.
    Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467(3):810–817PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Yang JH, Yoon JR, Oh CH, Kim TS (2012) Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees. Knee Surg Sports Traumatol Arthrosc 20(3):517–523PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Björn G. Ochs
    • 1
  • Anna J. Schreiner
    • 1
  • Peter M. de Zwart
    • 1
  • Ulrich Stöckle
    • 1
  • Christoph Emanuel Gonser
    • 1
    Email author
  1. 1.BG Trauma CentreEberhard Karls University of TübingenTübingenGermany

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