Download PDF
CC BY-NC-ND 4.0 · Joints 2018; 06(02): 090-094
DOI: 10.1055/s-0038-1660813
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Conventional versus Smart Wireless Navigation in Total Knee Replacement: Similar Outcomes in a Randomized Prospective Study

Matteo Denti
1   Istituto Ortopedico Galeazzi, Milan, Italy
,
Francesco Soldati
2   Clinica Luganese, Lugano, Switzerland
,
Francesca Bartolucci
2   Clinica Luganese, Lugano, Switzerland
,
Emanuela Morenghi
3   Biostatistics Unit, Istituto Clinico Humanitas, IRCCS, Milan, Italy
,
Laura De Girolamo
1   Istituto Ortopedico Galeazzi, Milan, Italy
,
Pietro Randelli
4   Università degli Studi di Milano, Milan, Italy
› Author Affiliations
Further Information

Publication History

06 November 2017

07 May 2018

Publication Date:
20 June 2018 (online)

   Permissions and Reprints

Abstract

Purpose The development of new computer-assisted navigation technologies in total knee arthroplasty (TKA) has attracted great interest; however, the debate remains open as to the real reliability of these systems. We compared conventional TKA with last generation computer-navigated TKA to find out if navigation can reach better radiographic and clinical outcomes.

Methods Twenty patients with tricompartmental knee osteoarthritis were prospectively selected for conventional TKA (n = 10) or last generation computer-navigated TKA (n = 10). Data regarding age, gender, operated side, and previous surgery were collected. All 20 patients received the same cemented posterior-stabilized TKA. The same surgical instrumentation, including alignment and cutting guides, was used for both the techniques. A single radiologist assessed mechanical alignment and tibial slope before and after surgery. A single orthopaedic surgeon performed clinical evaluation at 1 year after the surgery. Wilcoxon's test was used to compare the outcomes of the two groups. Statistical significance was set at p < 0.05.

Results No significant differences in mechanical axis or tibial slope was found between the two groups. The clinical outcome was equally good with both techniques. At a mean follow-up of 15.5 months (range, 13–25 months), all patients from both groups were generally satisfied with a full return to daily activities and without a significance difference between them.

Conclusion Our data showed that clinical and radiological outcomes of TKA were not improved by the use of computer-assisted instruments, and that the elevated costs of the system are not warranted.

Level of Evidence This is a Level II, randomized clinical trial.

Keywords

total knee arthroplasty - navigation - smart wireless - limb alignment - computer-assisted
 

  • References

  • 1 Ensini A, Timoncini A, Cenni F. , et al. Intra- and post-operative accuracy assessments of two different patient-specific instrumentation systems for total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 621-629
    CrossrefPubMedGoogle Scholar
  • 2 Liu Z, Pan X, Zhang X. Total knee arthroplasty using navigation system for severe osteoarthritis with extra-articular deformity. Eur J Orthop Surg Traumatol 2013; 23 (01) 93-96
    PubMedGoogle Scholar
  • 3 Mannan A, Smith TO, Sagar C, London NJ, Molitor PJ. No demonstrable benefit for coronal alignment outcomes in PSI knee arthroplasty: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2015; 101 (04) 461-468
    CrossrefPubMedGoogle Scholar
  • 4 Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi Jr AV. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 2012; 470 (01) 99-107
    CrossrefPubMedGoogle Scholar
  • 5 Sassoon A, Nam D, Nunley R, Barrack R. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res 2015; 473 (01) 151-158
    CrossrefPubMedGoogle Scholar
  • 6 Thienpont E, Fennema P, Price A. Can technology improve alignment during knee arthroplasty. Knee 2013; 20 (Suppl. 01) S21-S28
    CrossrefPubMedGoogle Scholar
  • 7 Cheng T, Zhao S, Peng X, Zhang X. Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1307-1322
    CrossrefPubMedGoogle Scholar
  • 8 Confalonieri N, Chemello C, Cerveri P, Manzotti A. Is computer-assisted total knee replacement for beginners or experts? Prospective study among three groups of patients treated by surgeons with different levels of experience. J Orthop Traumatol 2012; 13 (04) 203-210
    CrossrefPubMedGoogle Scholar
  • 9 Fu Y, Wang M, Liu Y, Fu Q. Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20 (06) 1075-1082
    CrossrefPubMedGoogle Scholar
  • 10 Schlatterer B, Linares JM, Chabrand P, Sprauel JM, Argenson JN. Influence of the optical system and anatomic points on computer-assisted total knee arthroplasty. Orthop Traumatol Surg Res 2014; 100 (04) 395-402
    CrossrefPubMedGoogle Scholar
  • 11 Blyth MJ, Smith JR, Anthony IC, Strict NE, Rowe PJ, Jones BG. Electromagnetic navigation in total knee arthroplasty-a single center, randomized, single-blind study comparing the results with conventional techniques. J Arthroplasty 2015; 30 (02) 199-205
    CrossrefPubMedGoogle Scholar
  • 12 Rhee SJ, Seo CH, Suh JT. Navigation-assisted total knee arthroplasty for patients with extra-articular deformity. Knee Surg Relat Res 2013; 25 (04) 194-201
    CrossrefPubMedGoogle Scholar
  • 13 Smith JR, Rowe PJ, Blyth M, Jones B. The effect of electromagnetic navigation in total knee arthroplasty on knee kinematics during functional activities using flexible electrogoniometry. Clin Biomech (Bristol, Avon) 2013; 28 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 14 Thiengwittayaporn S, Kanjanapiboonwong A, Junsee D. Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty. J Orthop Surg 2013; 8: 37
    CrossrefPubMedGoogle Scholar
  • 15 Thiengwittayaporn S, Junsee D, Tanavalee A. A comparison of blood loss in minimally invasive surgery with and without electromagnetic computer navigation in total knee arthroplasty. J Med Assoc Thai 2009; 92 (Suppl. 06) S27-S32
    PubMedGoogle Scholar
  • 16 Nam D, Weeks KD, Reinhardt KR, Nawabi DH, Cross MB, Mayman DJ. Accelerometer-based, portable navigation vs imageless, large-console computer-assisted navigation in total knee arthroplasty: a comparison of radiographic results. J Arthroplasty 2013; 28 (02) 255-261
    CrossrefPubMedGoogle Scholar
  • 17 Khan H, Walker PS, Zuckerman JD. , et al. The potential of accelerometers in the evaluation of stability of total knee arthroplasty. J Arthroplasty 2013; 28 (03) 459-462
    CrossrefPubMedGoogle Scholar
  • 18 Clayton AW, Cherian JJ, Banerjee S. , et al. Does the use of navigation in total knee arthroplasty affect outcomes?. J Knee Surg 2014; 27 (03) 171-175
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Carli A, Aoude A, Reuven A, Matache B, Antoniou J, Zukor DJ. Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect coronal alignment. Can J Surg 2014; 57 (05) 305-313
    CrossrefPubMedGoogle Scholar
  • 20 Catani F, Biasca N, Ensini A. , et al. Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty. J Bone Joint Surg Am 2008; 90 (04) 765-771
    CrossrefPubMedGoogle Scholar
  • 21 Benavente P, López Orosa C, Oteo Maldonado JA, Orois Codesal A, García Lázaro FJ. Computer assisted surgery. Its usefulness in different levels of pre-operative deformities. Rev Esp Cir Ortop Traumatol 2015; 59 (04) 245-253
    PubMedGoogle Scholar
  • 22 Shao JJ, Zhang XL, Wang Q, Chen YS, Shen H, Jiang Y. Total knee arthroplasty using computer assisted navigation in patients with severe valgus deformity of the knee. Chin Med J (Engl) 2010; 123 (19) 2666-2670
    PubMedGoogle Scholar
  • 23 Huang TW, Kuo LT, Peng KT, Lee MS, Hsu RW. Computed tomography evaluation in total knee arthroplasty: computer-assisted navigation versus conventional instrumentation in patients with advanced valgus arthritic knees. J Arthroplasty 2014; 29 (12) 2363-2368
    CrossrefPubMedGoogle Scholar
  • 24 Manzotti A, Confalonieri N, Pullen C. Intra-operative tibial fracture during computer assisted total knee replacement: a case report. Knee Surg Sports Traumatol Arthrosc 2008; 16 (05) 493-496
    CrossrefPubMedGoogle Scholar
  • 25 Tigani D, Busacca M, Moio A, Rimondi E, Del Piccolo N, Sabbioni G. Preliminary experience with electromagnetic navigation system in TKA. Knee 2009; 16 (01) 33-38
    CrossrefPubMedGoogle Scholar