Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation.

After obtaining informed consent, 80 patients were randomised to undergo a navigated or conventional total knee replacement. All received a cemented, unconstrained, cruciate-retaining implant with a rotating platform. Full-length standing and lateral radiographs and CT scans of the hip, knee and ankle joint were carried out five to seven days after operation. No notable differences were found between computer-assisted navigation and conventional implantation techniques as regards the rotational alignment of the femoral or tibial components. Although the deviation from the transepicondylar axis was relatively low, there was a considerable range of deviation for the tibial rotational alignment. There was no statistically significant difference regarding the occurrence pattern of outliers in mechanical malalignment but the number of outliers was reduced in the navigated group.

[1]  R. Barrack,et al.  Component Rotation and Anterior Knee Pain After Total Knee Arthroplasty , 2001, Clinical orthopaedics and related research.

[2]  Jan Victor,et al.  Image-Based Computer-Assisted Total Knee Arthroplasty Leads to Lower Variability in Coronal Alignment , 2004, Clinical orthopaedics and related research.

[3]  K A Krackow,et al.  A mathematical analysis of the effect of flexion and rotation on apparent varus/valgus alignment at the knee. , 1990, Orthopedics.

[4]  R. K. Mielke,et al.  [Navigation in knee endoprosthesis implantation--preliminary experiences and prospective comparative study with conventional implantation technique]. , 2001, Zeitschrift fur Orthopadie und ihre Grenzgebiete.

[5]  T. Albrecht,et al.  Rotationsfehlstellungen der Komponenten als Ursache chronischer Schmerzen und vorzeitigem Prothesenversagen bei Knieendoprothesen , 2003, Der Orthopäde.

[6]  B. Morrey Navigated Total Knee Replacement: A Meta-Analysis , 2008 .

[7]  J P Cobb,et al.  Computer navigation versus conventional total knee replacement. , 2007, The Journal of bone and joint surgery. British volume.

[8]  L. Dorr,et al.  Rationale of the Knee Society clinical rating system. , 1989, Clinical orthopaedics and related research.

[9]  C. Olcott,et al.  A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty. , 1998, The Journal of arthroplasty.

[10]  K. Buehler,et al.  Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. , 2005, The Journal of arthroplasty.

[11]  M Tingart,et al.  [Navigated implantation of total knee endoprostheses in secondary knee osteoarthritis of rheumatoid arthritis patients as compared to conventional technique]. , 2004, Zeitschrift fur Rheumatologie.

[12]  G. Konrad,et al.  [Early clinical outcome after navigated total knee arthroplasty. Comparison with conventional implantation in TKA: a controlled and prospective analysis]. , 2007, Der Orthopade.

[13]  Pak Lin Chin,et al.  Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. , 2005, The Journal of arthroplasty.

[14]  S. Hofmann,et al.  [Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty]. , 2003, Der Orthopade.

[15]  A Leardini,et al.  Alignments and Clinical Results in Conventional and Navigated Total Knee Arthroplasty , 2006, Clinical orthopaedics and related research.

[16]  W. Breidahl,et al.  Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. , 2004, The Journal of bone and joint surgery. British volume.

[17]  Arno Martin,et al.  Imageless Navigation for TKA Increases Implantation Accuracy , 2007, Clinical orthopaedics and related research.

[18]  N. Duncan Cell deformation and micromechanical environment in the intervertebral disc. , 2006, Journal of Bone and Joint Surgery. American volume.

[19]  Georg Matziolis,et al.  A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. , 2007, The Journal of bone and joint surgery. American volume.

[20]  Y.H. Kim,et al.  Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. , 2007, The Journal of bone and joint surgery. British volume.

[21]  Steffen Kohler,et al.  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. , 2005, The Journal of arthroplasty.

[22]  Oliver Kessler,et al.  The clinical consequences of flexion gap asymmetry in total knee arthroplasty. , 2007, The Journal of arthroplasty.

[23]  R. Brooks EuroQol: the current state of play. , 1996, Health policy.

[24]  Michael Nogler,et al.  Navigation Improves Accuracy of Rotational Alignment in Total Knee Arthroplasty , 2004, Clinical orthopaedics and related research.

[25]  R. Morris,et al.  Coronal alignment after total knee replacement. , 1991, The Journal of bone and joint surgery. British volume.

[26]  J. J. Jacobs,et al.  Malrotation Causing Patellofemoral Complications After Total Knee Arthroplasty , 1998, Clinical orthopaedics and related research.

[27]  C. Olcott,et al.  Femoral component rotation during total knee arthroplasty , 1999 .

[28]  M. Akagi,et al.  Variability of Extraarticular Tibial Rotation References for Total Knee Arthroplasty , 2005, Clinical orthopaedics and related research.

[29]  Michael Bottlang,et al.  Malrotation in total knee arthroplasty: effect on tibial cortex strain captured by laser-based strain acquisition. , 2006, Clinical biomechanics.

[30]  M. Janeček,et al.  Total knee arthroplasty implanted with and without kinematic navigation , 2003, International Orthopaedics.

[31]  R P Pitto,et al.  Accuracy of a computer-assisted navigation system for total knee replacement. , 2006, The Journal of bone and joint surgery. British volume.

[32]  M. Ritter,et al.  Tibial Component Failure Mechanisms in Total Knee Arthroplasty , 2004, Clinical orthopaedics and related research.

[33]  B. Beynnon,et al.  The Transepicondylar Axis Approximates the Optimal Flexion Axis of the Knee , 1998, Clinical orthopaedics and related research.

[34]  P. Lotke,et al.  Influence of positioning of prosthesis in total knee replacement. , 1977, The Journal of bone and joint surgery. American volume.

[35]  F. Daubresse,et al.  Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital. , 2005, Acta orthopaedica Belgica.

[36]  D. Zurakowski,et al.  Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. , 2004, The Journal of bone and joint surgery. British volume.

[37]  M. Ritter,et al.  Postoperative alignment of total knee replacement. Its effect on survival. , 1994, Clinical orthopaedics and related research.

[38]  Wolfhart Puhl,et al.  Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. , 2005, The Journal of arthroplasty.

[39]  上原 千典 Bone anatomy and rotational alignment in total knee arthroplasty , 2002 .

[40]  Masao Akagi,et al.  The functional flexion-extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique. , 2005, The Journal of arthroplasty.

[41]  S David Stulberg,et al.  Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. , 2006, The Journal of bone and joint surgery. American volume.

[42]  J. Grifka,et al.  Der navigationsgestützte bicondyläre Oberflächenersatz bei der sekundären Gonarthrose des RA-Patienten im Vergleich zur konventionellen Implantationstechnik , 2004, Zeitschrift für Rheumatologie.

[43]  Frederick W Werner,et al.  The effect of valgus/varus malalignment on load distribution in total knee replacements. , 2005, Journal of biomechanics.

[44]  U Holz,et al.  [CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study]. , 2003, Der Unfallchirurg.

[45]  D. Eckhoff,et al.  Malrotation Associated With Implant Alignment Technique in Total Knee Arthroplasty , 1995, Clinical orthopaedics and related research.

[46]  N. Confalonieri,et al.  Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. , 2005, Acta orthopaedica Belgica.

[47]  J. Huddleston,et al.  Determination of Neutral Tibial Rotational Alignment in Rotating Platform TKA , 2005, Clinical orthopaedics and related research.

[48]  C. Olcott,et al.  The Ranawat Award. Femoral component rotation during total knee arthroplasty. , 1999, Clinical orthopaedics and related research.

[49]  G. Konrad,et al.  Klinische und radiologische Ergebnisse nach navigierter Knieendoprothetik , 2007, Der Orthopäde.

[50]  D. Dennis,et al.  Correlation Between Condylar Lift-Off and Femoral Component Alignment , 2002, Clinical orthopaedics and related research.

[51]  Anthony J. Petrella,et al.  Optimizing Femoral Component Rotation in Total Knee Arthroplasty , 2001, Clinical orthopaedics and related research.

[52]  P Cinquin,et al.  [Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study]. , 2001, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[53]  D. S. Pandher,et al.  Computer-assisted navigation increases precision of component placement in total knee arthroplasty. , 2007, Clinical orthopaedics and related research.

[54]  D. Banzer,et al.  Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. , 2003, The Journal of bone and joint surgery. British volume.