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Computer Navigation-assisted versus Minimally Invasive TKA

Benefits and Drawbacks

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Computer-navigated and minimally invasive TKAs are emerging technologies that have distinct strengths and weaknesses. We compared duration of surgery, length of hospitalization, Knee Society scores, radiographic alignments, and complications in two unselected groups of 81 consecutive knees that underwent TKA using either a minimally invasive approach or computer navigation. The two groups were operated on by two different surgeons over differing timeframes. The mean surgical time was longer in the navigated group by 63 minutes. The Knee Society scores and lengths of hospitalization of the two groups were similar. The postoperative component alignments of the two groups were similar; the mean femoral valgus and tibial varus angles of the navigation group changed from 96° and 88° preoperatively to 95° and 89° postoperatively, respectively, and in the minimally invasive group, the mean femoral valgus angles and tibial varus angles changed from 97° and 88° preoperatively to 95° and 89° postoperatively, respectively. There were 11 major and three minor complications in the navigation group, including one revision, two femoral shaft fractures, four reoperations for knee stiffness, and four instances of bleeding from tracker sites. We believe the higher incidence of complications in addition to the longer operative time in the navigated group may outweigh any potential radiographic benefits.

Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am. 2004;86(Suppl 2):26–32.

    PubMed  Google Scholar 

  2. Chang CW, Yang CY. Kinematic navigation in total knee replacement—experience from the first 50 cases. J Formos Med Assoc. 2006;105:468–474.

    Article  PubMed  Google Scholar 

  3. Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br. 2004;86:372–377.

    Article  PubMed  CAS  Google Scholar 

  4. Chin PL, Yang KY, Yeo SJ, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty. 2005;20:618–626.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty. 2005;20:282–288.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res. 2007;457:156–162.

    PubMed  CAS  Google Scholar 

  9. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    PubMed  Google Scholar 

  10. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005;433:152–159.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Huang HT, Su JY, Chang JK, Chen CH, Wang GJ. The early clinical outcome of minimally invasive quadriceps-sparing total knee arthroplasty: report of a 2-year follow-up. J Arthroplasty. 2007;22:1007–1012.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  14. King J, Stamper DL, Schaad DC, Leopold SS. 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. 2007;89:1497–1503.

    Article  PubMed  Google Scholar 

  15. Kolisek FR, Bonutti PM, Hozack WJ, Purtill J, Sharkey PF, Zelicof SB, Ragland PS, Kester M, Mont MA, Rothman RH. Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach. J Arthroplasty. 2007;22:8–13.

    Article  PubMed  Google Scholar 

  16. Lombardi AV Jr, Viacava AJ, Berend KR. Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion. Clin Orthop Relat Res. 2006;452:117–122.

    Article  PubMed  Google Scholar 

  17. Martin A, von Strempel A. Two-year outcomes of computed tomography-based and computed tomography free navigation for total knee arthroplasties. Clin Orthop Relat Res. 2006;449:275–282.

    PubMed  Google Scholar 

  18. Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C. 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. 2007;89:236–243.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br. 2003;85:830–835.

    PubMed  CAS  Google Scholar 

  21. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426:180–186.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y. Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res. 2007;463:144–150.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Lindsay Rudert, Margo McMahon, Gina Zerrusen, and Colleen Kazmarek for collecting data and assisting with the preparation of the manuscript.

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Authors and Affiliations

  1. Bonutti Clinic, Effingham, IL, USA

    Peter M. Bonutti MD & Daniel Dethmers MD

  2. Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Slif D. Ulrich MD, Thorsten M. Seyler MD & Michael A. Mont MD

Authors
  1. Peter M. Bonutti MD
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  2. Daniel Dethmers MD
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  3. Slif D. Ulrich MD
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  4. Thorsten M. Seyler MD
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  5. Michael A. Mont MD
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Corresponding author

Correspondence to Michael A. Mont MD.

Additional information

One or more of the authors (PMB, DAD, MAM) are consultants for and receive funding from Stryker.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Bonutti, P.M., Dethmers, D., Ulrich, S.D. et al. Computer Navigation-assisted versus Minimally Invasive TKA. Clin Orthop Relat Res 466, 2756–2762 (2008). https://doi.org/10.1007/s11999-008-0429-7

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  • DOI: https://doi.org/10.1007/s11999-008-0429-7

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