Leg Axis After Computer-Navigated Total Knee Arthroplasty: A Prospective Randomized Trial Comparing Computer-Navigated and Manual Implantation
Section snippets
Patients and Methods
We compared 25 manually-implanted TKAs with 27 computer-navigated implantations. Patients included in the study had primary or secondary knee osteoarthritis severe enough for total knee arthroplasty. The study protocol and consent forms were approved by the local ethical committee. Sixty patients were considered for inclusion in the study. Six patients met 1 or 2 of the exclusion criteria defined and 2 patients did not give their consent, so that, finally, 52 patients entered the study. The
Demographic Data
The demographic data for the 2 groups of patients were similar. The mean age of the 25 patients who had a manual TKA was 67.3 years (SD, 3.3 years) compared with 64.7 years (SD, 9.4 years) for the 27 patients with a computer-navigated TKA. This difference was not significant (P = .30). The body mass index in the first group was calculated at 30.2 (SD, 4.95), compared with 27.9 (SD, 3.55) in the second group. This was not significantly different (P = .08). The demographic features of both groups
Clinical Evaluation and Scores at 3-Month Follow-Up
At the 3-month follow-up evaluation, the mean range of motion for the entire study group was 104° (SD, 17°). The differences in range of motion between the group that had a manually implanted prosthesis compared with the group who had a computer-navigated procedure were not significant (P = .369). We could not detect a significant difference in the overall clinical score of the Knee Society and the WOMAC as a disease-specific outcome measurement, as shown in Table 4.
Discussion
Basically, there are two fundamentally different ways of navigation in total knee arthroplasty. Some of the new navigation systems available today rely on reconstructed, 3-dimensional, Computer tomography-based models of the leg. Typically, these “image-based” models can be used for an intraoperative navigation, after matching bony landmarks, over an infrared link to a computer. These systems depend on a computer tomography, which leads to a higher dose of radiation and an increase in the
Acknowledgment
The authors thank Dr R. Muche of the Department of Biometrics and Medical Documentation of the University of Ulm for his help with the randomization and the statistical evaluation.
References (25)
- et al.
Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty
J. Arthroplasty
(1993) - et al.
The accuracy of femoral intramedullary guides in total knee arthroplasty
J. Arthroplasty
(1997) - et al.
Accuracy of intramedullary alignment in total knee replacement
J. Biomed. Eng.
(1992) - et al.
Alignment of total knee arthroplasty
J. Arthroplasty
(1989) - et al.
The effect of component malalignment on the clinical and radiological outcome of the Kinemax total knee replacement
Knee
(2003) - et al.
Mechanisms of failure of the femoral and tibial components in total knee arthroplasty
Clin. Orthop.
(1989) - et al.
Influence of positioning of prosthesis in total knee replacement
J. Bone Joint Surg. Am.
(1977) - et al.
Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty
Clin. Orthop.
(1995) - et al.
Intramedullary versus extramedullary femoral alignment systems in total knee replacement
Clin. Orthop.
(1993) - et al.
Computer assisted knee replacement
Clin. Orthop.
(1998)
Rationale of the knee society clinical rating system
Clin. Orthop.
Evaluation of a German version of the WOMAC osteoarthritis index
Z. Rheumatol.
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