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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
REVIEWS ADVANCES IN KNEE SURGERY LIGAMENT
Minerva Ortopedica e Traumatologica 2010 June;61(3):203-19
New on minimally invasive computer-assisted navigated total knee arthroplasty (MIS CA-TKA)
Biasca N., Bungartz M.
Orthopedic Clinic, Trauma Surgery, Department of Surgery, Spital Oberengadin, Samedan, St. Moritz, Switzerland
The Stryker Knee Navigation system aids the surgeon in the minimally invasive computer-assisted total knee arthroplasty (TKA) to optimize mechanical and rotational alignments of the components as well as to avoid any malrotation and/or any error in coronal, sagittal and axial alignments. In contrast to even the most elaborate mechanical instrumentation system, which relies on visual inspection to confirm the accuracy of the alignment and stability of the TKA, computer-assisted navigation allows the surgeon to objectify every operative cut by using the so called resection plane probe, which allows a three dimensional control of the cut planes on the screen, the position of trials and finally of the implants. Furthermore, this computer-assisted navigation helps the surgeon to reliably measure not only the kinematics but also the stability of TKA through the full range of movement on a screen. Moreover, surgeons have the opportunity to improve their surgical performance with a direct intraoperative documentation of alignment and orientation of instruments, trials and implants. These advantages improve the accuracy of every single cut. Thus, the advantages of minimal soft tissue damage in minimally invasive surgery (MIS)-TKA (reduced length of hospital stay and early mobilization) can be achieved without loss of accuracy. However, correct positioning of the components may only be a co-factor together with instability and soft tissue trauma with MIS approach, leading to suboptimal implant loading with early loosening and increased wear. Much technical expertise in the conventional TKA, the skill of the surgeons and their familiarity with the instruments may also be necessary to obtain good results.