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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
HIP AND KNEE RECONSTRUCTION
Minerva Ortopedica e Traumatologica 2009 June;60(3):249-54
Computer-assisted versus non-navigated total knee arthroplasty: a review
Martin A., Widemschek M., Von Strempel A.
University Teaching Hospital Medical University of Innsbruck Feldkirch, Austria
Different studies confirmed the increased radiological implantation accuracy for computer assisted total knee replacements. There was no study stating a significant influence of the navigation technique for total knee arthroplasty (TKA) on the early clinical outcomes. In a primary trial (44 TKAs) the authors compared the computed tomography (CT) based navigation technique with the CT free surgical navigation technique. In a second trial the authors did a prospective comparative randomized study (200 TKA) comparing navigated with conventional implantation technique. Pre- and postoperatively in all cases clinical (Insall score parameter, step test, anterior knee pain, feeling of instability) and radiologic parameters (mechanical axis of the leg, tibial slope, lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA]) were acquired. The comparison of the CT based and CT free navigation technique showed no significant differences for the radiologic and clinical parameters. The trial comparing navigated with conventional implantation technique showed significantly improved implantation accuracies for the mechanical axis of the leg and the tibial slope in the navigation study group. The clinical parameters at the 3-month follow-up were not significantly different. Based on their experiences and the information from the literature the authors defined the following indications for navigated total knee replacements: obesity, post-traumatic deformities of the femur or tibia, retained hardware, severe preoperative flexion contracture (>10°), and the impossibility of generating an exact long leg weightbearing anteroposterior radiograph for an appropriate preoperative conventional surgery planning.