1
|
Lee WT, Chin PL, Lo NN, Yeo SJ. Short-term outcome after computer-assisted versus conventional total knee arthroplasty: a randomised controlled trial. J Orthop Surg (Hong Kong) 2015; 23:71-5. [PMID: 25920649 DOI: 10.1177/230949901502300117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the short-term functional outcome after computer-assisted total knee arthroplasty (TKA) versus conventional TKA. METHODS 23 men and 67 women aged 48 to 80 years were randomised to undergo (1) conventional TKA using an intramedullary guide, (2) conventional TKA using an extramedullary guide, or (3) computer-assisted TKA. Two senior surgeons performed all the TKAs using the same TKA system and the standard anteromedial arthrotomy with eversion of the patella. Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey, Oxford Knee Score, and Knee Society Score. RESULTS Of the 90 patients, 67 and 70 were assessed at 6 months and 2 years after TKA, respectively. No patient developed deep infection or required revision surgery. Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups. CONCLUSION Significant improvement in the functional outcome was not shown in patients treated with computer-assisted TKA, compared with conventional TKA. Thus, computer-assisted TKA has limited additional short-term benefits. Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA.
Collapse
Affiliation(s)
- Wei Ting Lee
- Department of Orthopaedic Surgery, Singapore General Hospital
| | | | | | | |
Collapse
|
2
|
Abdel MP, Parratte S, Blanc G, Ollivier M, Pomero V, Viehweger E, Argenson JNA. No benefit of patient-specific instrumentation in TKA on functional and gait outcomes: a randomized clinical trial. Clin Orthop Relat Res 2014; 472:2468-76. [PMID: 24604110 PMCID: PMC4079860 DOI: 10.1007/s11999-014-3544-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/20/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although some clinical reports suggest patient-specific instrumentation in TKA may improve alignment, reduce surgical time, and lower hospital costs, it is unknown whether it improves pain- and function-related outcomes and gait. QUESTIONS/PURPOSES We hypothesized that TKA performed with patient-specific instrumentation would improve patient-reported outcomes measured by validated scoring tools and level gait as ascertained with three-dimensional (3-D) analysis compared with conventional instrumentation 3 months after surgery. METHODS We randomized 40 patients into two groups using either patient-specific instrumentation or conventional instrumentation. Patients were evaluated preoperatively and 3 months after surgery. Assessment tools included subjective functional outcome and quality-of-life (QOL) scores using validated questionnaires (New Knee Society Score(©) [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], and SF-12). In addition, gait analysis was evaluated with a 3-D system during level walking. The study was powered a priori at 90% to detect a difference in walking speed of 0.1 m/second, which was considered a clinically important difference, and in a post hoc analysis at 80% to detect a difference of 10 points in KSS. RESULTS There were improvements from preoperatively to 3 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level walking. However, there was no difference between the patient-specific instrumentation and conventional instrumentation groups in KSS, KOOS, SF-12, or 3-D gait parameters. CONCLUSIONS Our observations suggest that patient-specific instrumentation does not confer a substantial advantage in early functional or gait outcomes after TKA. It is possible that differences may emerge, and this study does not allow one to predict any additional variances in the intermediate followup period from 6 months to 1 year postoperatively. However, the goals of the study were to investigate the recovery period as early pain and functional outcomes are becoming increasingly important to patients and surgeons. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions to Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Matthew P. Abdel
- />Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Sébastien Parratte
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France , />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Guillaume Blanc
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Matthieu Ollivier
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Vincent Pomero
- />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Elke Viehweger
- />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Jean-Noël A. Argenson
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France , />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| |
Collapse
|
3
|
Functional outcomes following total knee arthroplasty: a randomised trial comparing computer-assisted surgery with conventional techniques. Knee 2014; 21:364-8. [PMID: 24703685 DOI: 10.1016/j.knee.2013.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/19/2013] [Accepted: 04/01/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND A number of trials have shown improved radiological alignment following total knee arthroplasty using computer-assisted surgery (CAS) compared with conventional surgery. Few studies, however, have looked at functional outcomes. METHODS We prospectively studied a cohort of 107 patients that underwent TKA by a single surgeon. Patients were randomised into 3 groups: computer-assisted surgery for both the femur and the tibia, intramedullary guides for both the femur and the tibia, and an intramedullary guide for the femur and an extramedullary guide for the tibia. Patients were followed-up post-operatively with the Short Form Health Survey (SF-12) and Oxford Knee Score (OKS) questionnaires. RESULTS At a median follow-up of 46 months (range 30-69 months), there was a trend towards higher OKS results in the CAS group, with a mean score of 40.6 in the CAS group compared to 37.6 in the extramedullary group and 36.8 in the intramedullary group. The difference seen in the OKS between CAS and the conventional groups had a significant unadjusted p-value (0.024), and approached significance when adjusted for age and sex (0.054). There was a significant improvement in the OKS when the mechanical axis was within ±3° of neutral, versus those outside this range (median of 41.0 compared to 38.3, p=0.045). DISCUSSION This study shows that clinically significant differences are being seen in functional scores of patients treated with CAS versus conventional guides, at medium-term follow up. Our findings reinforce the tenet that a coronal mechanical axis of within 3° of neutral equates to significantly better functional outcomes.
Collapse
|
4
|
de Souza Leão MG, Santos Santoro E, Lima Avelino R, Inoue Coutinho L, Campos Granjeiro R, Orlando Junior N. Quality-of-life assessment among patients undergoing total knee arthroplasty in Manaus. Rev Bras Ortop 2014; 49:194-201. [PMID: 26229799 PMCID: PMC4511687 DOI: 10.1016/j.rboe.2014.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/09/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE this study had the aim of assessing the quality of life among patients undergoing total knee arthroplasty (TKA). For this, the SF-36 and WOMAC questionnaires respectively were used to make comparisons with preoperative values. METHODS a prospective observational cohort study was conducted, with blinded analysis on the results from 107 TKAs in 99 patients, between June 2010 and October 2011. The present study included 55 knees/patients, among whom 73% were female and 27% were male. The patients' mean age was 68 years. The SF-36 and WOMAC questionnaires (which have been validated for the Portuguese language) were applied immediately before and six months after the surgical procedure. RESULTS the statistical and graphical analyses indicated that the variables presented normal distribution. From the data, it was seen that all the indices underwent positive changes after the surgery. CONCLUSIONS despite the initial morbidity, TKA is a very successful form of treatment for severe osteoarthritis of the knee (i.e. more than two joint compartments affected and/or Ahlback classification greater than 3), from a functional point of view, with improvement of the patients' quality of life, as confirmed in the present study. This study presented evidence level IV (description of case series), with analysis on the results, without a comparative study.
Collapse
Affiliation(s)
| | - Erika Santos Santoro
- Orthopedics and Traumatology Service, Fundação Hospital Adriano Jorge, Manaus, AM, Brazil
| | - Rafael Lima Avelino
- Orthopedics and Traumatology Service, Fundação Hospital Adriano Jorge, Manaus, AM, Brazil
| | - Lucas Inoue Coutinho
- Orthopedics and Traumatology Service, Fundação Hospital Adriano Jorge, Manaus, AM, Brazil
| | | | - Nilton Orlando Junior
- Orthopedics and Traumatology Service, Fundação Hospital Adriano Jorge, Manaus, AM, Brazil
| |
Collapse
|
5
|
Leão MGDS, Santos Santoro E, Lima Avelino R, Inoue Coutinho L, Campos Granjeiro R, Orlando Junior N. Avaliação da qualidade de vida em pacientes submetidos à artroplastia total do joelho em Manaus. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
6
|
Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2013; 21:2234-40. [PMID: 23114870 DOI: 10.1007/s00167-012-2284-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Recently, new custom-fit pin guides in total knee arthroplasty (TKA) have been introduced. Use of these guides may reduce operating time. Use of the guides combined with the absence of intramedullary alignment jigs may lead to reduced blood loss and improved early outcomes. Our aim was to evaluate blood loss and early clinical outcomes in patients undergoing minimally invasive TKA using custom-fit magnetic resonance imaging (MRI)-based pin guides. METHODS A prospective study in 80 patients was carried out. Patients were divided randomly into 2 equal groups. In one group, intramedullary alignment jigs were used. In the second group, custom-fit MRI-based pin guides were used. All patients received the same cemented posterior-stabilized implant through a mini-midvastus approach. The volume in the drain bottles was recorded after 48 h. Hb loss was estimated by subtracting the postoperative from the preoperative Hb level. Transfusion requirements and surgical time were recorded. Outcome measures were Knee Society Scores (KSS), knee flexion, knee swelling and pain. RESULTS There was lower mean drainage of blood in the custom-fit group (391 ml vs. 603 ml; p < 0.0001). There was no difference in estimated loss of Hb (3.6 g/dl vs. 4.1 g/dl; n.s.) and in transfusion requirements (7.5 % vs. 10 %; n.s.). Surgical time was reduced in the custom-fit group (12 min less; p = 0.001). KSS measured at week 2, 6 and 12 showed no significant difference between groups. Knee flexion measured on days 7, 10 and at week 6, 12 and knee swelling and pain measured on days 1, 3, 10 and at week 6, 12 showed no significant difference between groups. CONCLUSIONS Using custom-fit pin guides reduces blood drainage, but not the estimated Hb loss in minimally invasive TKA and does not affect transfusion rate. Surgical time is reduced. There is no effect on the early clinical outcomes. LEVEL OF EVIDENCE Therapeutic study, Level I.
Collapse
|
7
|
|
8
|
Cheng T, Pan XY, Mao X, Zhang GY, Zhang XL. Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 2012; 19:237-45. [PMID: 22130355 DOI: 10.1016/j.knee.2011.10.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 09/25/2011] [Accepted: 10/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Even though computer-assisted navigation systems have been shown to improve the accuracy of implantation of components into the femur and tibia, long-term results are lacking and there is little evidence yet that navigation techniques also improve functional outcomes and implant longevity following total knee arthroplasty (TKA). The aim of this study was to summarize and compare the clinical outcomes of total knee arthroplasties (TKAs) performed using navigation-assisted and conventional techniques. METHODS The study was conducted according to the guidelines described in the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements. Methodological features were rated independently by two reviewers. A meta-analysis of randomized controlled trials (RCTs) or quasi- randomized controlled trials (qRCTs) was carried out to evaluate the efficacy of CAS versus conventional TKA. Data were pooled in fixed and random effects models and the weighted mean difference (WMD) and odds ratio (OR) were calculated. Heterogeneity across studies was determined, and subgroup analyses by the type of navigation system (image-based or image-free navigation system) were conducted. RESULTS Twenty-one studies that included 2333 knees were collected from different countries. The surgical time was longer for CN TKA than for the conventional procedure. There was no significant difference in the Knee Society Score between the two groups at the 3-month and 6-month follow-up. The rates of postoperative complications in patients who had CN TKA were similar to those in the patients who had conventional TKA. CONCLUSION No significant differences in short-term clinical outcomes were found following TKAs performed with and without computer navigation system. However, there is clearly a need for additional high-quality clinical trials with long-term follow-up to confirm the clinical benefits of computer-assisted surgery.
Collapse
Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yisan Road, Shanghai 200233, People's Republic of China
| | | | | | | | | |
Collapse
|
9
|
Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 2012; 20:1307-22. [PMID: 21732057 DOI: 10.1007/s00167-011-1588-8] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/16/2011] [Indexed: 01/21/2023]
Abstract
PURPOSE Computer-assisted surgery has been proposed as a technique to improve implant alignment during total knee arthroplasty (TKA). However, there is still a debate over the accuracy of placing the femoral and tibial components using computer-assisted systems in TKA. The aim of this study is to establish whether computer-assisted surgery leads to superior mechanical leg axis and implant positioning than conventional technique in patients with primary TKA. METHODS Major electronic databases were systematically searched to identify relevant studies without language restriction. A meta-analysis of 41 randomized controlled trials (RCTs) or quasi-RCTs was performed in a random effects model. A subgroup analysis was conducted by type of navigation system to explore the clinical heterogeneity between these trials. The following radiographic parameters were used to compare computer-assisted surgery with conventional technique: (1) mechanical leg axis, (2) femoral component coronal alignment, (3) tibial component coronal alignment, (4) femoral component sagittal alignment, and (5) tibial component sagittal alignment. RESULTS For the mechanical leg axis and coronal positioning of femoral and tibial components, there are statistically significant reductions in the number of patients with malalignment in the CAS group if the outlier cutoff value is ±3 or 2° in the coronal and sagittal planes, respectively. Subgroup analysis demonstrates that CT-free navigation systems provide better alignment than conventional techniques in the coronal and sagittal alignment of femoral components within ±3 and 2°. If the outlier cutoff value for the tibial sagittal alignment is ±2°, the outlier percentages are higher in the CT-free navigation group than in the conventional group. However, there was no significant difference in the tibial sagittal alignment at ±3°. CONCLUSION Computer-assisted surgery does improve mechanical leg axis and component orientation in TKAs. However, high-quality RCTs are necessary to determine whether surgeons could use computer-assisted techniques to achieve a targeted tibial slope in TKA. LEVEL OF EVIDENCE Therapeutic study (Systematic review of Level I/II studies), Level II.
Collapse
|
10
|
Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 2012; 470:99-107. [PMID: 21809150 PMCID: PMC3237987 DOI: 10.1007/s11999-011-1996-6] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. QUESTIONS/PURPOSES We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. METHODS We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. RESULTS The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3° hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9° versus 90.4°) and femoral (90.7° versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the rate of ± 2° outliers was similar for both the tibia (10% versus 7%) and femur (22% versus 18%). CONCLUSIONS Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.
Collapse
Affiliation(s)
- Vincent Y. Ng
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH USA
| | | | - Keith R. Berend
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH USA ,Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA ,Mount Carmel Health System, New Albany, OH USA
| | - Bethany C. Gulick
- Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
| | - Adolph V. Lombardi
- Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA ,Mount Carmel Health System, New Albany, OH USA ,Department of Orthopaedics and Department of Biomedical Engineering, The Ohio State University Medical Center, Columbus, OH USA
| |
Collapse
|
11
|
da Mota E Albuquerque RF. NAVIGATION IN TOTAL KNEE ARTHROPLASTY. Rev Bras Ortop 2011; 46:18-22. [PMID: 27026979 PMCID: PMC4799223 DOI: 10.1016/s2255-4971(15)30169-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 11/14/2010] [Indexed: 11/05/2022] Open
Abstract
Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established.
Collapse
|
12
|
Lehnen K, Giesinger K, Warschkow R, Porter M, Koch E, Kuster MS. Clinical outcome using a ligament referencing technique in CAS versus conventional technique. Knee Surg Sports Traumatol Arthrosc 2011; 19:887-92. [PMID: 20852843 PMCID: PMC3096770 DOI: 10.1007/s00167-010-1264-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 08/31/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Computer-assisted surgery (CAS) for total knee arthroplasty (TKA) has become increasingly common over the last decade. There are several reports including meta-analyses that show improved alignment, but the clinical results do not differ. Most of these studies have used a bone referencing technique to size and position the prosthesis. The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs. METHODS We performed a prospective cohort study comparing clinical outcome of navigated TKA (43 patients) with that of conventional TKA (122 patients). Patients were assessed preoperatively, and 2 and 12 months postoperatively by an independent study nurse using validated patient-reported outcome tools as well as clinical examination. RESULTS At 2 months, there was no difference between the two groups. However, after 12 months, CAS was associated with significantly less pain and stiffness, both at rest and during activities of daily living, as well as greater overall patient satisfaction. CONCLUSION The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score (P=0.002) and Knee Society score (P=0.040) 1 year after surgery in using a ligament referencing technique. Furthermore, 91% were extremely or very satisfied in the CAS TKA group versus 70% after conventional TKA (P=0.007).
Collapse
MESH Headings
- Aged
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Chi-Square Distribution
- Cohort Studies
- Female
- Follow-Up Studies
- Humans
- Joint Instability/prevention & control
- Knee Prosthesis
- Length of Stay/trends
- Ligaments, Articular/physiology
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/surgery
- Pain Measurement
- Postoperative Complications/physiopathology
- Preoperative Care/methods
- Prospective Studies
- Prosthesis Design
- Prosthesis Failure
- Range of Motion, Articular/physiology
- Surgery, Computer-Assisted/adverse effects
- Surgery, Computer-Assisted/methods
- Treatment Outcome
Collapse
Affiliation(s)
- K. Lehnen
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Rorschacherstrasse 97, 9007 St. Gallen, Switzerland
| | - K. Giesinger
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Rorschacherstrasse 97, 9007 St. Gallen, Switzerland
| | - R. Warschkow
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Rorschacherstrasse 97, 9007 St. Gallen, Switzerland
| | - M. Porter
- Calvary Clinic, Haydon Drive, Bruce, ACT 2617 Australia
| | - E. Koch
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Rorschacherstrasse 97, 9007 St. Gallen, Switzerland
| | - M. S. Kuster
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Rorschacherstrasse 97, 9007 St. Gallen, Switzerland
| |
Collapse
|
13
|
Cheng T, Zhang G, Zhang X. Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 2010; 171:590-600. [PMID: 21176919 DOI: 10.1016/j.jss.2010.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/04/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of computer-assisted surgery is to improve accuracy and limit the range of surgical variability. However, a worldwide debate exists regarding the importance and usefulness of computer-assisted navigation for total knee arthroplasty (TKA). The main purpose of this study is to summarize and compare the radiographic outcomes of TKA performed using imageless computer-assisted navigation compared with conventional techniques. MATERIALS AND METHODS An electronic search of PubMed, EMBASE, Web of Science, and Cochrane library databases was made, in addition to manual search of major orthopedic journals. A meta-analysis of 29 quasi-randomized/randomized controlled trials (quasi-RCTs/RCTs) and 11 prospective comparative studies was conducted through a random effects model. Additional a priori sources of clinical heterogeneity were evaluated by subgroup analysis with regard to radiographic methods. RESULTS When the outlier cut-off value of lower limb axis was defined as ±2° or ±3° from the neutral, the postoperative full-length radiographs demonstrated that the risk ratio was 0.54 or 0.39, respectively, which were in favor of the navigated group. When the cut-off value used for the alignment in the coronal and sagittal plane was 2° or 3°, imageless navigation significantly reduced the outlier rate of the femoral and tibial components compared with the conventional group. Notably, computed tomography scans demonstrated no statistically significant differences between the two groups regarding the outliers in the rotational alignment of the femoral and tibial components; however, there was strong statistical heterogeneity. CONCLUSIONS Our results indicated that imageless computer-assisted navigation systems improve lower limb axis and component orientation in the coronal and sagittal planes, but not the rotational alignment in TKA. Further multiple-center clinical trials with long-term follow-up are needed to determine differences in the clinical and functional outcomes of knee arthroplasties performed using computer-assisted techniques.
Collapse
Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | | | | |
Collapse
|
14
|
Dickhaus H, Metzner R. [Biomedical engineering supports surgical planning and interventions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:791-800. [PMID: 20700778 DOI: 10.1007/s00103-010-1100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fundamental changes were achieved with the introduction of minimally invasive surgery. In this context, innovations in microtechnology played a significant role in the deployment of new tools. Developments for further integration are still ongoing. Furthermore, decisive progress was made by the timely provision of individual patient data prior to surgery. These comprise imaging data, electrophysiological or functional recordings, and synthetic data gained by modeling and simulation of anatomical or physiological conditions. Aside from the technical aspects of supporting surgery, effective quality management and optimized workflow are essential for therapeutic success. The vision of autonomously operating robots has been dropped in favor of permanently conducted and supervised interventions with the support of intelligent tools for the surgeon. Recent advances in reconstruction and transplantation surgery by tissue engineering and molecular biology are only the beginning of new promising concepts.
Collapse
Affiliation(s)
- H Dickhaus
- Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Deutschland.
| | | |
Collapse
|
15
|
Peterlein CD, Schofer MD, Fuchs-Winkelmann S, Scherf FG. Clinical outcome and quality of life after computer-assisted total knee arthroplasty: results from a prospective, single-surgeon study and review of the literature. Musculoskelet Surg 2009; 93:115-122. [PMID: 19876709 DOI: 10.1007/s12306-009-0042-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 10/09/2009] [Indexed: 05/28/2023]
Abstract
Despite excellent results, there is a lack of prospective studies analysing functional outcome and quality of life after computer-navigated total knee arthroplasty. Fifty-two patients were investigated before and 6 months after surgery with the OrthoPilot navigation system (Aesculap, Germany). We used the SF-36 Health Survey, the visual analog scale (VAS), the Lequesne score and the Knee Society Score (KSS) for assessment. The operation was carried out by one single surgeon. At follow-up, the study population achieved a significant pain reduction on the VAS from 71 to 21 points, an average decline of the Lequesne score from 16 to 7 points coming along with a significant ascent of the KSS from 84 to 157 points. Concerning the SF-36 Health Survey, most of the patients re-achieved age- and gender-matched scores. Poor results were obtained in patients with multiple comorbidities and a severe flexion contracture preoperative.
Collapse
Affiliation(s)
- Christian-Dominik Peterlein
- Department of Orthopaedics and Rheumatology, University Hospital Giessen and Marburg, Baldingerstrasse, Marburg, Germany.
| | | | | | | |
Collapse
|
16
|
Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S. Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. ACTA ACUST UNITED AC 2008; 90:1039-44. [PMID: 18669959 DOI: 10.1302/0301-620x.90b8.20553] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
Collapse
Affiliation(s)
- J Lützner
- Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
| | | | | | | | | |
Collapse
|