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

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 090-094 ◽  
Author(s):  
Matteo Denti ◽  
Francesco Soldati ◽  
Francesca Bartolucci ◽  
Emanuela Morenghi ◽  
Laura De Girolamo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tibial Slope ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Level Ii ◽  
Before And After ◽  
Total Knee ◽  
Generation Computer ◽  
Navigated Tka

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.

scholarly journals NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

2018 ◽  
Vol 26 (3) ◽  
pp. 170-174 ◽  
Author(s):  
IZUMI TANI ◽  
NAOKI NAKANO ◽  
KOJI TAKAYAMA ◽  
KAZUNARI ISHIDA ◽  
RYOSUKE KURODA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Radiographic Outcomes ◽  
Navigation Group ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

scholarly journals Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Raj Kanna ◽  
Chandramohan Ravichandran ◽  
Gautam M. Shetty
Keyword(s):  
Femoral Component ◽  
Distal Femur ◽  
Mechanical Axis ◽  
Computer Assisted ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Anterior Cortex ◽  
Level Ii ◽  
Navigated Tka ◽  
Very High

Abstract Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence Therapeutic level II.

scholarly journals Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Dongquan Shi ◽  
Xingquan Xu ◽  
Anyun Guo ◽  
Jin Dai ◽  
Zhihong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Mechanical Alignment ◽  
Early Loosening ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

scholarly journals Intra-operative Laxity Following Total Knee Arthroplasty is Highly Variable and Different Than Osteoarthritic and Normal Knees

2020 ◽  
Author(s):  
Robert A. Siston ◽  
Erin E. Hutter ◽  
Joseph A. Ewing ◽  
Rachel K. Hall ◽  
Jeffrey F. Granger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Laxity ◽  
Maximum Load ◽  
Similar Data ◽  
Level Of Evidence ◽  
Large Variability ◽  
Level Ii ◽  
Total Knee ◽  
Manual Manipulation

AbstractBackgroundAchieving a stable joint is an important yet challenging part of total knee arthroplasty (TKA). Neither manual manipulation of the knee nor instrumented sensors biomechanically characterize knee laxity or objectively characterize how TKA changes the laxity of an osteoarthritic (OA) knee. Therefore, the purposes of this study were: 1) objectively characterize changes in knee laxity due to TKA, 2) objectively determine whether TKA resulted in equal amounts of varus-valgus motion under a given load (i.e., balance) and 3) determine how TKA knee laxity and balance differ from values seen in non-osteoarthritic knees.MethodsTwo surgeons used a custom navigation system and intra-operative device to record varus-valgus motion under quantified loads in a cohort of 31 patients (34 knees) undergoing primary TKA. Similar data previously were collected from a cohort of 42 native cadaveric knees.ResultsPerforming a TKA resulted in a “looser knee” on average, but great variability existed within and between surgeons. Under the maximum applied moment, 20 knees were “looser” in the varus-valgus direction, while 14 were “tighter”. Surgeon 1 generally “loosened” knees (OA laxity 6.1°±2.3°, TKA laxity 10.1°±3.6°), while Surgeon 2 did not substantially alter knee laxity (OA laxity 8.2°±2.4°, TKA laxity 7.5°±3.3°). TKA resulted in balanced knees, and, while several differences in laxity were observed between OA, TKA, and cadaveric knees, balance was only different under the maximum load between OA and cadaveric knees.ConclusionsLarge variability exists within and between surgeons suggests in what is considered acceptable laxity and balance of the TKA knee when it is assessed by only manual manipulation of the leg. Knees were “balanced” yet displayed different amounts of motion under applied load.Clinical RelevanceOur results suggest that current assessments of knee laxity may leave different patients with biomechanically different knees. Objective intra-operative measurements should inform surgical technique to ensure consistency across different patients.Level of EvidenceLevel II prospective observational study

scholarly journals Reliability of Imageless Computer-Assisted Navigation for Femoral Rotational Alignment in Total Knee Arthroplasty

2021 ◽  
Vol 15 (1) ◽  
pp. 79-84
Author(s):  
Leelasestaporn C ◽  
Thuwapitchayanant M ◽  
Sirithanapipat P ◽  
Sa-ngasoongsong P ◽  
Ruengsilsuwit P
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Total Knee

scholarly journals Computer assisted navigation in total knee and hip arthroplasty

SICOT-J ◽  
2017 ◽  
Vol 3 ◽  
pp. 50 ◽  
Author(s):  
Kamal Deep ◽  
Shivakumar Shankar ◽  
Ashish Mahendra
Keyword(s):  
Hip Arthroplasty ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

scholarly journals Accuracy of femoral rotational alignment in total knee arthroplasty using computer assisted navigation

2008 ◽  
Vol 13 (3) ◽  
pp. 167-172 ◽  
Author(s):  
Camilo Restrepo ◽  
William J. Hozack ◽  
Fabio Orozco ◽  
Javad Parvizi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Total Knee

scholarly journals Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094022
Author(s):  
Jonathan H. Garfinkel ◽  
Amelia Hummel ◽  
Jonathan Day ◽  
Andrew Roney ◽  
Mackenzie Jones ◽  
...  
Keyword(s):  
Health Literacy ◽  
Objective Measure ◽  
Senior Author ◽  
Bachelor's Degree ◽  
Level Of Evidence ◽  
Verbal Instructions ◽  
Level Ii ◽  
Before And After ◽  
History Of ◽  
Poor Health Literacy

Background: Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. Methods: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled. Results: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. Conclusion: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. Level of Evidence: Level II, prospective cohort study.

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