COMPARISON OF TOTAL KNEE ARTHROPLASTY WITH COMPUTER NAVIGATION SYSTEMS AND CONVENTIONAL TECHNIQUES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUZhihong , CHENDongyang , SHIDongquan , DAIJin ,  JIANGQing

Department of Orthopedics, Affiliated Drum Tower Hospital, Medical College of Nanjing University, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

JIANGQing, Email: jiangqing112@hotmail.com

Keywords：

Computer navigation; Total knee arthroplasty; Limb alignment

DOI：

10.7507/1002-1892.20140233

Video：

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Objective To evaluate the value of total knee arthroplasty (TKA) with computer navigation by comparing with conventional TKA. Methods Between May 2010 and December 2011, 45 patients underwent primary unilateral TKA, and the clinical data were retrospectively analyzed. Of 45 patients, 22 cases were treated with TKA with computer navigation (group A), 23 cases with the conventional TKA (group B). There was no significant difference in gender, age, body mass index, side, cause of disease, disease duration, preoperative range of motion (ROM) of the knee, and preoperative Hospital for Special Surgery (HSS) score between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incidence of patellar retinacular release, complication, and drainage volume were compared. The prosthesis loosening, postoperative HSS score, and ROM of the knee were also compared. Results No difference was found in the incidence of patellar retinacular release during TKA, and it was 13.6% (3/22) in group A and was 4.3% (1/23) in group B, showing no significant difference (χ²=1.198, P=0.346). The operation time of group A was significantly longer than that of group B (t=7.557, P=0.000). There was no significant difference in intraoperative blood loss during TKA between 2 groups (t=-0.295, P=0.769), while the drainage volume of group A was significantly less than that of group B (t=-2.419, P=0.020). Incomplete fracture during TKA and acute infection occurred at 8 days after TKA in 1 case of group A respectively, while no fracture or infection was found in group B, showing significant difference (Z=-0.509, P=0.000). The patients of 2 groups were followed up 27-46 months. No significant difference in valgus and varus of knee, and malalignment of the femoral and tibial prosthesis was found (P > 0.05). There was no significant difference in HSS score and ROM of the knee at last follow-up between 2 groups (P > 0.05). No prosthesis loosening was found in 2 groups. Conclusion TKA with computer navigation has similar results to conventional TKA in the mechanical alignment, but it obviously prolongs operation time. It may also increase the incidence of infection and tractor pin related fracture.

Citation： XUZhihong, CHENDongyang, SHIDongquan, DAIJin, JIANGQing. COMPARISON OF TOTAL KNEE ARTHROPLASTY WITH COMPUTER NAVIGATION SYSTEMS AND CONVENTIONAL TECHNIQUES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1066-1071. doi: 10.7507/1002-1892.20140233 Copy

1.	Choong PF, Dowsey MM, Stoney JD.Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty.J Arthroplasty, 2009, 24(4):560-569.
2.	Sikorski JM.Alignment in total knee replacement.J Bone Joint Surg (Br), 2008, 90(9):1121-1127.
3.	MacDessi SJ, Jang B, Harris IA, et al.A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty.Knee, 2014, 21(2):406-409.
4.	Friederich N, Verdonk R.The use of computer-assisted orthopedic surgery for total knee replacement in daily practice:a survey among ESSKA/SGO-SSO members.Knee Surg Sports Traumatol Arthrosc, 2008, 16(6):536-543.
5.	Nakahara H, Matsuda S, Okazaki K, et al.Sagittal cutting error changes femoral anteroposterior sizing in total knee arthroplasty.Clin Orthop Relat Res, 2012, 470(12):3560-3565.
6.	Tigani D, Masetti G, Sabbioni G, et al.Computer-assisted surgery as indication of choice:total knee arthroplasty in case of retained hardware or extra-articular deformity.Int Orthop, 2012, 36(7):1379-1385.
7.	Millar NL, Deakin AH, Millar LL, et al.Blood loss following total knee replacement in the morbidly obese:Effects of computer navigation.Knee, 2011, 18(2):108-112.
8.	McConnell J, Dillon J, Kinninmonth A, et al.Blood loss following total knee replacement is reduced when using computer-assisted versus standard methods.Acta Orthop Belg, 2012, 78(1):75-79.
9.	Bellemans J, Vandenneucker H, Vanlauwe J, et al.The influence of coronal plane deformity on mediolateral ligament status:an observational study in varus knees.Knee Surg Sports Traumatol Arthrosc, 2010, 18(2):152-156.
10.	Cheng T, Zhang G, Zhang X.Clinical and radiographic outcomes of image-based computer-assisted total knee arthroplasty:an evidence-based evaluation.Surg Innov, 2011, 18(1):15-20.
11.	Jung KA, Lee SC, Ahn NK, et al.Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty.J Arthroplasty, 2011, 26(3):505.e9-e11.
12.	Hoke D, Jafari SM, Orozco F, et al.Tibial shaft stress fractures resulting from placement of navigation tracker pins.J Arthroplasty, 2011, 26(3):504.e5-e8.
13.	Kong CG, Park SW, Yang H, et al.The effect of femoral component design on patellar tracking in total knee arthroplasty:GenesisⅡprosthesis versus Vanguard prosthesis.Arch Orthop Trauma Surg, 2014, 134(4):571-576.
14.	Nakano N, Matsumoto T, Ishida K, et al.Long-term subjective outcomes of computer-assisted total knee arthroplasty.Int Orthop, 2013, 37(10):1911-1915.
15.	Dyrhovden GS, Gøthesen Ø, Lygre SH, et al.Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 198 knees operated at a Norwegian district hospital.BMC Musculoskelet Disord, 2013, 14:321.
16.	Zhang GQ, Chen JY, Chai W, et al.Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures:a randomized clinical trial.J Bone Joint Surg (Am), 2011, 93(13):1190-1196.
17.	Ishida K, Matsumoto T, Tsumura N, et al.Mid-term outcomes of computer-assisted total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc, 2011, 19(7):1107-1112.
18.	Lützner J, Dexel J, Kirschner S.No difference between computer-assisted and conventional total knee arthroplasty:five-year results of a prospective randomised study.Knee Surg Sports Traumatol Arthrosc, 2013, 21(10):2241-2247.
19.	Moskal JT, Capps SG, Mann JW, et al.Navigated versus conventional total knee arthroplasty.J Knee Surg, 2014, 27(3):235-248.
20.	Hoppe S, Mainzer JD, Frauchiger L, et al.More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up.Acta Orthop, 2012, 83(6):629-633.
21.	Confalonieri N, Chemello C, Cerveri P, et al.Is computer-assisted total knee replacement for beginners or experts? Prospective study among three groups of patients treated by surgeons with different levels of experience.J Orthop Traumatol, 2012, 13(4):203-210.

1. Choong PF, Dowsey MM, Stoney JD.Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty.J Arthroplasty, 2009, 24(4):560-569.
2. Sikorski JM.Alignment in total knee replacement.J Bone Joint Surg (Br), 2008, 90(9):1121-1127.
3. MacDessi SJ, Jang B, Harris IA, et al.A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty.Knee, 2014, 21(2):406-409.
4. Friederich N, Verdonk R.The use of computer-assisted orthopedic surgery for total knee replacement in daily practice:a survey among ESSKA/SGO-SSO members.Knee Surg Sports Traumatol Arthrosc, 2008, 16(6):536-543.
5. Nakahara H, Matsuda S, Okazaki K, et al.Sagittal cutting error changes femoral anteroposterior sizing in total knee arthroplasty.Clin Orthop Relat Res, 2012, 470(12):3560-3565.
6. Tigani D, Masetti G, Sabbioni G, et al.Computer-assisted surgery as indication of choice:total knee arthroplasty in case of retained hardware or extra-articular deformity.Int Orthop, 2012, 36(7):1379-1385.
7. Millar NL, Deakin AH, Millar LL, et al.Blood loss following total knee replacement in the morbidly obese:Effects of computer navigation.Knee, 2011, 18(2):108-112.
8. McConnell J, Dillon J, Kinninmonth A, et al.Blood loss following total knee replacement is reduced when using computer-assisted versus standard methods.Acta Orthop Belg, 2012, 78(1):75-79.
9. Bellemans J, Vandenneucker H, Vanlauwe J, et al.The influence of coronal plane deformity on mediolateral ligament status:an observational study in varus knees.Knee Surg Sports Traumatol Arthrosc, 2010, 18(2):152-156.
10. Cheng T, Zhang G, Zhang X.Clinical and radiographic outcomes of image-based computer-assisted total knee arthroplasty:an evidence-based evaluation.Surg Innov, 2011, 18(1):15-20.
11. Jung KA, Lee SC, Ahn NK, et al.Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty.J Arthroplasty, 2011, 26(3):505.e9-e11.
12. Hoke D, Jafari SM, Orozco F, et al.Tibial shaft stress fractures resulting from placement of navigation tracker pins.J Arthroplasty, 2011, 26(3):504.e5-e8.
13. Kong CG, Park SW, Yang H, et al.The effect of femoral component design on patellar tracking in total knee arthroplasty:GenesisⅡprosthesis versus Vanguard prosthesis.Arch Orthop Trauma Surg, 2014, 134(4):571-576.
14. Nakano N, Matsumoto T, Ishida K, et al.Long-term subjective outcomes of computer-assisted total knee arthroplasty.Int Orthop, 2013, 37(10):1911-1915.
15. Dyrhovden GS, Gøthesen Ø, Lygre SH, et al.Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 198 knees operated at a Norwegian district hospital.BMC Musculoskelet Disord, 2013, 14:321.
16. Zhang GQ, Chen JY, Chai W, et al.Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures:a randomized clinical trial.J Bone Joint Surg (Am), 2011, 93(13):1190-1196.
17. Ishida K, Matsumoto T, Tsumura N, et al.Mid-term outcomes of computer-assisted total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc, 2011, 19(7):1107-1112.
18. Lützner J, Dexel J, Kirschner S.No difference between computer-assisted and conventional total knee arthroplasty:five-year results of a prospective randomised study.Knee Surg Sports Traumatol Arthrosc, 2013, 21(10):2241-2247.
19. Moskal JT, Capps SG, Mann JW, et al.Navigated versus conventional total knee arthroplasty.J Knee Surg, 2014, 27(3):235-248.
20. Hoppe S, Mainzer JD, Frauchiger L, et al.More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up.Acta Orthop, 2012, 83(6):629-633.
21. Confalonieri N, Chemello C, Cerveri P, et al.Is computer-assisted total knee replacement for beginners or experts? Prospective study among three groups of patients treated by surgeons with different levels of experience.J Orthop Traumatol, 2012, 13(4):203-210.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF TOTAL KNEE ARTHROPLASTY WITH COMPUTER NAVIGATION SYSTEMS AND CONVENTIONAL TECHNIQUES

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