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Accelerometer-based portable navigation, a faster guide compared to computer-assisted navigation in bilateral total knee arthroplasty—a randomized controlled study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There are limited studies in the literature comparing the alignment accuracy of  the large console, imageless, computer-assisted navigation (CAN) and portable, hand-held, accelerometer-based navigation (ABN) in total knee arthroplasty (TKA).  This study was aimed to compare the operative time, blood loss, radiological, clinical and functional outcomes between CAN- and ABN-guided bilateral TKA.

Methods

From Jan 2016 to Dec 2017, 50 patients who underwent bilateral TKA were randomized to undergo either CAN-guided or ABN-guided TKA. Tourniquet time and blood loss were recorded, and intra-op complications were noted. Post-op radiological outcomes at 2 weeks were compared between the groups. The clinical and functional outcomes using the American Knee Society Scores (KSS) and Oxford Knee Score (OKS) were recorded pre-operatively and post-operatively at 3, 6, 12 months and at the end of the study with a minimum follow-up of 48 months.

Results

Both groups were well-matched in terms of patient demographic parameters. The mean surgical time per knee was significantly lower in the ABN group (54.5 ± 5.6 min) compared to the CAN group (61.7 ± 13.7 min; p < 0.01). Mean blood loss per knee in the ABN group was 592.1 ± 245.3 mL compared to 682.8 ± 322.0 in the CAN group (p = 0.11). In the ABN group, the mean post-op mechanical axis was 1.2 ± 3.2° (vs 1.5 ± 2.2° in the CAN group, p 0.6), the frontal femoral angle was 88.8 ± 2.3° (vs 88.8 ± 1.8° in the CAN group, p 1.0) and frontal tibial angle was 90.1 ± 1.6° (vs 89.7 ± 1.1° in the CAN group, p 0.14). At 48 month follow-up, the mean functional KSS in the ABN group was 89.0 ± 5.7 (vs 88.1 ± 4.5 in the CAN group, p 0.37) and the mean OKS was 40.5 ± 2.8 (vs 39.6 ± 3.2 in the CAN group, p 0.12).

Conclusion

Portable, hand-held ABN offers alignment accuracy and functional outcomes in TKA similar to that with CAN, with a reduced duration of surgery. There was no advantage of either of the techniques in terms of clinical or functional outcomes at 48 month follow-up.

Level of evidence 1.

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Funding

No funding was received from any source for this study.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Arun M Swamy, Rajesh Malhotra, Vijaykumar Digge, Vikrant Manhas & Deepak gautam

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Deep Narayana Srivastava

  3. Department of Orthopaedics, Room No 139, Teaching Block, All India Institute of Medical Sciences (AIIMS), Ansari Nagar East, New Delhi, 110029, India

    Rajesh Malhotra

Authors
  1. Arun M Swamy
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  2. Rajesh Malhotra
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  3. Vijaykumar Digge
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  4. Vikrant Manhas
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  5. Deepak gautam
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  6. Deep Narayana Srivastava
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Contributions

AS drafted the manuscript. RM conceived the study and performed all the surgeries. VD and VM participated in the design of the study. VM and DG performed the post-operative clinical and functional scoring. DS and AS independently measured the various radiological angles. RM shaped the final version of the manuscript. All the authors read and approved the manuscript.

Corresponding author

Correspondence to Rajesh Malhotra.

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Conflict of interest

All the authors have no conflict of interest.

Ethical approval

The study was approved by institute ethics committee, AIIMS, New Delhi, India and was registered under Clinical trials Registry of India (CTRI). All the procedures performed in the study involving human participants were in accordance with the ethical standards of the Institutional and/or the National Research Committee and with 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed and written consent was taken from all the patients who had participated in the study.

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Swamy, A.M., Malhotra, R., Digge, V. et al. Accelerometer-based portable navigation, a faster guide compared to computer-assisted navigation in bilateral total knee arthroplasty—a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 31, 786–792 (2023). https://doi.org/10.1007/s00167-021-06842-y

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  • DOI: https://doi.org/10.1007/s00167-021-06842-y

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