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Hand-held navigation may improve accuracy in minimally invasive total knee arthroplasty: a prospective randomized controlled trial

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A novel hand-held navigation combines gyroscopes, accelerometers and a secure local wireless channel to guide the distal femoral and proximal tibial cutting positions by displaying to the surgeon directly on the pods within the surgical field. No previous study has reported on its accuracy.

Materials and methods

A prospective randomized controlled trial was performed to compare radiographic outcomes in minimally invasive surgery total knee arthroplasty (MIS-TKA) with (40 patients, 40 knees) and without (40 patients, 40 knees) the novel hand-held navigation.


The use of hand-held navigation resulted in fewer outliers (> ± 3° malalignment) in all frontal alignment: the hip-knee-ankle, the femoral component, and the tibial component. Tibial slope was also better achieved with the navigation. Femoral component flexion was not significantly different. Operation time and bone cutting time with the navigation were not longer than those without. Blood loss from drainage was not significantly different.


The hand-held navigation improves accuracy for mechanical alignment and positioning of the prosthesis without additional surgical time.

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  1. 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 

  2. Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 24(4):570–578. doi:10.1016/j.arth.2008.03.002

    Article  PubMed  Google Scholar 

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

    CAS  Google Scholar 

  4. Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J (2011) Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop 35(3):331–339. doi:10.1007/s00264-010-1008-6

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ (2011) Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty 26(3):505 e509–505 e511. doi:10.1016/j.arth.2010.01.006

    Article  Google Scholar 

  6. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  7. Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg (Br) 89(4):471–476. doi:10.1302/0301-620X.89B4.18878

    Article  Google Scholar 

  8. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89(2):261–269. doi:10.2106/JBJS.F.00601

    Article  PubMed  Google Scholar 

  9. Manzotti A, Cerveri P, Pullen C, Confalonieri N (2014) Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique. Int Orthop 38(2):457–463. doi:10.1007/s00264-013-2215-8

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saragaglia D, Picard F, Refaie R (2012) Navigation of the tibial plateau alone appears to be sufficient in computer-assisted unicompartmental knee arthroplasty. Int Orthop 36(12):2479–2483. doi:10.1007/s00264-012-1679-2

    Article  PubMed  PubMed Central  Google Scholar 

  11. Maderbacher G, Schaumburger J, Keshmiri A, Barthel M, Springorum HR, Craiovan B, Grifka J, Baier C (2015) Pinless navigation in total knee arthroplasty: Navigation reduced by the maximum? Int Orthop 39(3):455–460. doi:10.1007/s00264-014-2529-1

    Article  PubMed  Google Scholar 

  12. Lachiewicz PF, Henderson RA (2013) Patient-specific instruments for total knee arthroplasty. J Am Acad Orthop Surg 21(9):513–518. doi:10.5435/JAAOS-21-09-513

    Article  PubMed  Google Scholar 

  13. Russell R, Brown T, Huo M, Jones R (2014) Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg. doi:10.1055/s-0034-1368143

    Google Scholar 

  14. Thienpont E, Schwab PE, Fennema P (2014) A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Joint J 96-B(8):1052–1061. doi:10.1302/0301-620X.96B8.33747

    Article  PubMed  CAS  Google Scholar 

  15. Lackey WG, Berend ME (2012) Hand-held navigation in total knee arthroplasty. J Bone Joint Surg (Br) 94(11 Suppl A):151–152. doi:10.1302/0301-620X.94B11.30831

    Article  CAS  Google Scholar 

  16. Nam D, Weeks KD, Reinhardt KR, Nawabi DH, Cross MB, Mayman DJ (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):255–261. doi:10.1016/j.arth.2012.04.023

    Article  PubMed  Google Scholar 

  17. Nam D, Cross M, Deshmane P, Jerabek S, Kang M, Mayman DJ (2011) Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty. Orthopedics 34(10):e615–e621. doi:10.3928/01477447-20110826-12

    PubMed  Google Scholar 

  18. Khan H, Walker PS, Zuckerman JD, Slover J, Jaffe F, Karia RJ, Kim JH (2013) The potential of accelerometers in the evaluation of stability of total knee arthroplasty. J Arthroplasty 28(3):459–462. doi:10.1016/j.arth.2012.07.025

    Article  PubMed  Google Scholar 

  19. Scuderi GR, Fallaha M, Masse V, Lavigne P, Amiot LP, Berthiaume MJ (2014) Total knee arthroplasty with a novel navigation system within the surgical field. Orthop Clin North Am 45(2):167–173. doi:10.1016/j.ocl.2013.11.002

    Article  PubMed  Google Scholar 

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The patients’ expenses for the TKA were covered by a public healthcare program. NK received a scholarship for her MS study from Thailand Graduate Institute of Science and Technology (TGIST), TG-CPMO 01-56-008.

Conflict of interest

ST is a paid consultant for Zimmer. The remaining authors declare that they have no conflict of interest.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Correspondence to Satit Thiengwittayaporn.

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Thiengwittayaporn, S., Fusakul, Y., Kangkano, N. et al. Hand-held navigation may improve accuracy in minimally invasive total knee arthroplasty: a prospective randomized controlled trial. International Orthopaedics (SICOT) 40, 51–57 (2016).

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