Skip to main content
SpringerLink
Log in

Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome

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

Abstract

Purpose

Correct alignment of the leg and positioning of the components are important factors in good long-term outcome of total knee arthroplasty (TKA). Computer-assisted navigation systems were introduced to improve component alignment accuracies. The three main hypotheses of this study were that the navigated compared to jig-based patient will show the following: (1) No difference in clinical outcomes. (2) Better alignment in the frontal and sagittal plane. (3) Better rotational positioning of components.

Methods

The authors evaluated 100 patients who had minimally invasive TKA using either an image-free computer-assisted navigation system (n = 50) or a jig-based technique (n = 50). Six months postoperatively, clinical and radiological evaluations were performed using full-length standing anteroposterior and lateral radiographs and CT scans of the knee.

Results

Knee Society knee score, function score, and range of motion were comparable in the two groups after surgery. The percentage of patients with a frontal tibiofemoral angle within ±3° of the ideal was significantly higher in the navigated group than in the jig-based group (94% vs. 78%, respectively; P = 0.041). No significant differences were found between groups in terms of the frontal and sagittal planes as well as rotational alignment of the femoral or tibial components.

Conclusion

Computer-assisted TKA gives a better correction of alignment of the leg compared with jig-based TKA when combined with a minimally invasive surgical approach.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89-A:261–269

    Article  Google Scholar 

  2. Bäthis H, Perlick L, Tingart M, Lüring 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-B:682–687

    Article  Google Scholar 

  3. Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47

    PubMed  Google Scholar 

  4. Biasca N, Wirth S, Bungartz M (2009) Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee 16:22–29

    Article  PubMed  Google Scholar 

  5. Bonutti PM, Dethmers DA, McGrath MS, Ulrich SD, Mont MA (2008) Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res 466:2730–2735

    Article  PubMed  Google Scholar 

  6. Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA (2008) Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res; 466:2756–2762

    Article  PubMed  Google Scholar 

  7. 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-B:372–377

    Article  Google Scholar 

  8. 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 20:618–626

    Article  PubMed  Google Scholar 

  9. Confalonieri N, Manzotti A, Pullen C, Ragone V (2007) Mini-incision versus mini-incision and computer-assisted surgery in total knee replacement: a radiological prospective randomised study. Knee 14:443–447

    Article  PubMed  Google Scholar 

  10. Dalury DF, Dennis DA (2005) Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77–81

    Article  PubMed  Google Scholar 

  11. 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 20:618–626

    Article  Google Scholar 

  12. Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 90-B:2–9

    Article  Google Scholar 

  13. 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 

  14. Haas SB, Cook S, Beksac B (2004) Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 428:68–73

    Article  PubMed  Google Scholar 

  15. Haas SB, Manitta MA, Burdick P (2006) Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop Relat Res 452:112–116

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  17. 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 

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

    Google Scholar 

  19. Jung HJ, Jung YB, Song KS, Park SJ, Lee JS (2007) Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am 89-A:2280–2284

    Article  Google Scholar 

  20. Kashyap SN, van Ommeren JW (2008) Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study. Knee Surg Sports Traumatol Arthrosc 16:544–548

    Article  PubMed  Google Scholar 

  21. 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-B:471–476

    Article  Google Scholar 

  22. Kim YH, Kim JS, Choi Y, Kwon OR (2009) Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 91-A:14–19

    Article  Google Scholar 

  23. King J, Stamper DL, Schaad DC, Leopold SS (2007) Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty, Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 89-A:1497–1503

    Article  Google Scholar 

  24. Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC et al (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81

    Article  PubMed  Google Scholar 

  25. Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59-A:77–79

    Google Scholar 

  26. Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M (2008) Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 16:928–934

    Article  PubMed  Google Scholar 

  27. Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90-B:1039–1044

    Article  Google Scholar 

  28. Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22:1097–1106

    Article  PubMed  Google Scholar 

  29. Matsui Y, Kadoya Y, Uehara K, Kobayashi A, Takaoka K (2005) Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clin Orthop Relat Res 433:147–151

    Article  PubMed  Google Scholar 

  30. Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89-A:236–243

    Article  Google Scholar 

  31. Mizu-uchi H, Matsuda S, Miura H, Higaki H, Okazaki K, Iwamoto Y (2006) The effect of ankle rotation on cutting of the tibia in total knee arthroplasty. J Bone Joint Surg Am 88-A:2632–2636

    Article  Google Scholar 

  32. Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y (2008) The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br 90-B:1025–1031

    Article  Google Scholar 

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

    Article  Google Scholar 

  34. Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  36. Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:249–257

    Article  PubMed  Google Scholar 

  37. Seon JK, Song EK (2006) Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty 21:777–782

    Article  PubMed  Google Scholar 

  38. Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG (2007) Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg 12:189–193

    PubMed  CAS  Google Scholar 

  39. Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87-A:2276–2280

    Article  Google Scholar 

  40. Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69

    Article  PubMed  Google Scholar 

  41. 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 85:830–835

    PubMed  CAS  Google Scholar 

  42. Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89-A:477–480

    Google Scholar 

  43. Stöckl 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 

  44. Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98

    PubMed  Google Scholar 

  45. Stulberg SD, Yaffe MA, Koo SS (2006) Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88-A(Suppl 4):47–54

    Article  Google Scholar 

  46. Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan

    Masahiro Hasegawa, Kakunoshin Yoshida, Hiroki Wakabayashi & Akihiro Sudo

Authors
  1. Masahiro Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kakunoshin Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akihiro Sudo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masahiro Hasegawa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hasegawa, M., Yoshida, K., Wakabayashi, H. et al. Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome. Knee Surg Sports Traumatol Arthrosc 19, 904–910 (2011). https://doi.org/10.1007/s00167-010-1253-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1253-7

Keywords

Search

Navigation