J Knee Surg 2013; 26(02): 127-132
DOI: 10.1055/s-0032-1319788
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Limb Alignment, Component Positioning, and Function in Primary Total Knee Arthroplasty Using a Pinless Navigation Technique Compared with Conventional Methods

Brian J. Keyes
1   Department of Orthopaedic Surgery, Indiana University, Indianapolis, Indiana
,
David C. Markel
2   Department of Orthopaedic Surgery, St. John Providence Hospital, Southfield, Michigan
,
Robert Michael Meneghini
3   Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Further Information

Publication History

16 March 2012

08 April 2012

Publication Date:
13 July 2012 (online)

Abstract

The purpose of this study was to examine component positioning, limb alignment, and the early functional range of motion of a pinless image-free computer-assisted navigation system, and compare it to conventional intramedullary component alignment methods. A total of 72 patients underwent cemented total knee arthroplasty. The pinless navigation group consisted of 40 knees in 39 patients, while the conventional group comprised 33 knees in 33 patients. Preoperative and postoperative radiographs were evaluated for coronal and sagittal alignment. Functional assessment was evaluated by early postoperative range of motion. There was no statistical significance when examining individual component alignment or early functional range of motion. When evaluating ability to achieve overall anatomic tibiofemoral alignment within a range of 4 to 7 degrees valgus, the conventional group was able to accomplish this 39% of the time, whereas the pinless navigation group succeeded in 65% of cases (p < 0.03). The tourniquet time was mean 59.5 minutes (range: 48 to 77 minutes) for the conventional group, compared with mean 71.9 minutes (range: 54 to 97 minutes) for the navigation group (p < 0.0001, 95% CI). The pinless navigation technique improved coronal anatomic alignment without complications that have been cited with use of femoral or tibial reference tracker pins or intramedullary alignment guides.

 
  • References

  • 1 Deirmengian CA, Lonner JH. Specialty Update: what's new in adult reconstructive surgery. J Bone Joint Surg Am 2010; 92: 2753-2764
  • 2 Molli RG, Anderson KC, Buehler KC, Markel DC. Computer-assisted navigation software advancements improve the accuracy of total knee arthroplasty. J Arthroplasty 2011; 26 (3) 432-438
  • 3 Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005; 20 (7, Suppl 3) 132-138
  • 4 Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK. Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 2005; 20 (7) 832-839
  • 5 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 (6) 830-835
  • 6 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 (2) 236-243
  • 7 Krackow KA, Phillips MJ, Bayers-Thering M, Serpe L, Mihalko WM. Computer-assisted total knee arthroplasty: navigation in TKA. Orthopedics 2003; 26 (10) 1017-1023
  • 8 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (4) 560-569
  • 9 Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty 2009; 24 (5) 668-673
  • 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 (433) 152-159
  • 11 Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 2004; 86 (5) 682-687
  • 12 Bonutti P, Dethmers D, Stiehl JB. Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 2008; 466 (6) 1499-1502
  • 13 Li CH, Chen TH, Su YP, Shao PC, Lee KS, Chen WM. Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system. J Arthroplasty 2008; 23 (2) 304-307
  • 14 Sikorski JM, Blythe MC. Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br 2005; 87 (7) 903-910
  • 15 Hernández-Vaquero D, Suárez-Vázquez A. Complications of fixed infrared emitters in computer-assisted total knee arthroplasties. BMC Musculoskelet Disord 2007; 8: 71
  • 16 Hoke D, Jafari SM, Orozco F, Ong A. Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty 2011; 26 (3) 504 , e5–e8
  • 17 Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ. Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty 2011; 26 (3) 505 , e9–e505, e11
  • 18 Jung HJ, Jung YB, Song KS, Park SJ, Lee JS. Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am 2007; 89 (10) 2280-2284
  • 19 Beldame J, Boisrenoult P, Beaufils P. Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res 2010; 96 (3) 249-255
  • 20 Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computer navigated total knee arthroplasty. Knee 2006; 13 (5) 397-399
  • 21 Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ. Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplasty 2008; 23 (3) 462-465
  • 22 Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A. Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty 2007; 22 (7) 953-959
  • 23 Massai F, Conteduca F, Vadalà A, Iorio R, Basiglini L, Ferretti A. Tibial stress fracture after computer-navigated total knee arthroplasty. J Orthop Traumatol 2010; 11 (2) 123-127
  • 24 Panasiuk M, Bończak O. Fatigue fracture of the femur after navigated total knee replacement. Ortop Traumatol Rehabil 2009; 11 (1) 72-77
  • 25 Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 1995; 321 (321) 168-172
  • 26 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; 24 (248) 9-12
  • 27 Bargren JH, Blaha JD, Freeman MAR. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983; 173 (173) 178-183
  • 28 Berend ME, Ritter MA, Meding JB , et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; 428 (428) 26-34
  • 29 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
  • 30 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6 Suppl) 39-43