Skip to main content
SpringerLink
Log in

Computergesteuerte Navigation in der Kniegelenkendoprothetik

Computer-assisted navigation in total knee arthroplasty

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Computernavigation entwickelt sich mehr und mehr zum Standardverfahren in der primären Kniegelenkendoprothetik. Gerade in den letzten Jahren hat sich gezeigt, dass sich nicht nur Beinachse und Implantatposition, sondern auch Bandführung sowie Korrektur intra- und extraartikulär gelegener Knochendeformitäten mithilfe der Computernavigation zuverlässig beurteilen und einstellen lassen. Wo früher gekoppelte Prothesen nötig waren, können heute Oberflächenersatzprothesen implantiert werden. Bei posttraumatischer Gonarthrose hat sich die Methode ganz besonders bewährt, da hier neben Knochendeformitäten oft Bandinstabilitäten und/oder -kontrakturen zu korrigieren sind. Dabei weist das Verfahren klinisch keine wesentlichen Nachteile, sondern eher eine Reihe von Vorteilen auf. Unter Würdigung aller Umstände ist anzunehmen, dass die Navigationstechnik mittel- und langfristig kosteneffektiv ist. Der endgültige Beweis hierzu steht jedoch noch aus.

Abstract

Computer-assisted navigation is increasingly developing into a standard procedure in total knee arthroplasty. Recently it was shown that computer navigation not only corrects leg alignment and positioning of the prosthesis but also allows a precise ligament balancing as well as a better judgment and an accurate tuning of intra-articular and extra-articular bone deformities. Nowadays asurface replacement prostheses can be implanted in many cases where a constraint solution was previously necessary. The method is useful particularly in patients with posttraumatic arthritis by straightening out bone deformities and adjusting unstable and/or scarred ligaments. The procedure does not have any essential disadvantages and on the contrary computer-assisted navigation seems to provide even more benefits. Economically it can be anticipated that computer-assisted navigation will be cost-effective in the medium and long term but the final proof is still lacking.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Bäthis H, Shafizadeh S, Paffrath T et al (2006) Sind navigierte Knieendoprothesen tatsächlich präziser implantiert? Orthopade 35:1056–1065

    Article  PubMed  Google Scholar 

  2. Berend ME, Ritter MA, Meding JB et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34

    Article  PubMed  Google Scholar 

  3. Cerha O, Kirschner S, Günther KP, Lützner J (2009) Cost analysis for navigation in knee endoprosthetics Orthopade 38(12):1235–1240

  4. Chotanaphuti T, Ongnamthip P, Teeraleekul K, Kraturerk C (2008) Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study. J Med Assoc Thai 91(9):1382–1388

    PubMed  Google Scholar 

  5. Coull R, Bankes MJK, Rossouw DJ (1999) Evaluation of tibial component angles in 79 consecutive total knee arthroplasty. Knee 5:165–174

    Google Scholar 

  6. Delp SL, Stulberg SD, Davies B et al (1998) Computer assisted knee replacement. Clin Orthop 354:49–56

    Article  PubMed  Google Scholar 

  7. Feng EL, Stulberg SD, Wixson RL (1994) Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. Clin Orthop 299:60–71

    PubMed  Google Scholar 

  8. Fehring TK, Odum S, Griffin WL et al (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318

    Article  PubMed  Google Scholar 

  9. Galaud B, Beaufils P, Michaut M et al (2008) Distal femoral torsion: comparison of CT scan and intra operative navigation measurements during total knee arthroplasty. A report of 70 cases. Rev Chir Orthop Reparatrice Appar Mot 94(6):573–579

    CAS  PubMed  Google Scholar 

  10. Gallie PA, Davis ET, Macgroarty K et al (2010) Computer-assisted navigation for the assessment of fixed flexion in knee arthroplasty. Can J Surg 53(1):42–46

    PubMed  Google Scholar 

  11. Han SB, Nha KW, Yoon JR et al (2008) The reliability of navigation-guided gap technique in total knee arthroplasty. Orthopedics 31 [10 Suppl 1]

  12. Hsu HP, Garg A, Walker PS et al (1989) Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop (248):135–144

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  14. Kalairajah Y, Cossey AJ, Verrall GM et al (2006) Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomized, clinical trial. J Bone Joint Surg Br 88:198–202

    CAS  PubMed  Google Scholar 

  15. Lim HC, Bae JH, Neogi DS et al (2009) Rotational alignment of femoral component and flexion gap balance in patients with distal femoral torsional deformity using navigation-assisted TKA. Orthopedics 32 [10 Suppl]:52–55

  16. Löer I, Plitz W (2003) Tibial malalignment of mobile-bearing prostheses – a simulator study. Orthopade 32(4):296–304

    Article  PubMed  Google Scholar 

  17. Lüring C, Hüfner T, Perlick L et al (2005) Soft tissue management in knees with varus deformity. Computer-assisted sequential medial ligament release. Orthopade 34(11):1118, 1120–1122, 1124

    Article  PubMed  Google Scholar 

  18. Mahaluxmivala J, Bankes MJ, Nicolai P et al (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  CAS  PubMed  Google Scholar 

  19. Mielke RK, Clemens U, Jens JH, Kershally S (2001) Navigation in der Knieendoprothetik – Vorläufige klinische Erfahrungen und prospektiv vergleichende Studie gegenüber konventioneller Implantationstechnik. Z Orthop Ihre Grenzgeb 139(2):109–116

    Article  CAS  PubMed  Google Scholar 

  20. Novak EJ, Silverstein MD, Bozic KJ (2007) The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 89(11):2389–2397

    Article  PubMed  Google Scholar 

  21. Pitto RP, Graydon AJ, Bradley L et al (2006) Accuracy of computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br 88:601–605

    Article  CAS  PubMed  Google Scholar 

  22. Ranawat CS, Flynn WF Jr, Saddler S et al (1993) Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop 286:94–102

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  25. Seon JK, Park SJ, Lee KB et al (2009) Functional comparison of total knee arthroplasty performed with and without a navigation system. Int Orthop 33(4):987–990

    Article  PubMed  Google Scholar 

  26. Song EK, Seon JK, Park SJ (2009) Flexion-extension gaps balanced using navigation assistance in TKA. Orthopedics 32 [10 Suppl]:26–30

  27. Stöckl B, Nogler M, Rosiek R et al (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res (426):180–186

    Article  Google Scholar 

  28. Sühwold J, Mägerlein S, Schulz AP et al (2009) Was ist der Benefit der Navigation bei der Totalen Knieendoprothetik (TKA) nach posttraumatischer Arthrose? Poster 1.26. 184. Tagung der Vereinigung Nordwestdeutscher Chirurgen, Hamburg, 3.–5.12.2009

  29. Tew M, Waugh W (1985) Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 67(4):551–556

    CAS  PubMed  Google Scholar 

  30. Tenholder M, Clarke HD, Scuderi GR (2005) Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res 440:67–76

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland

    P.M. de Zwart, K. Weise & U. Ochs

Authors
  1. P.M. de Zwart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Weise
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Ochs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P.M. de Zwart.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Zwart, P., Weise, K. & Ochs, U. Computergesteuerte Navigation in der Kniegelenkendoprothetik. Trauma Berufskrankh 12, 107–112 (2010). https://doi.org/10.1007/s10039-010-1631-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-010-1631-x

Schlüsselwörter

Keywords

Search

Navigation