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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2011

01.06.2011 | Knee

Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome

verfasst von: Masahiro Hasegawa, Kakunoshin Yoshida, Hiroki Wakabayashi, Akihiro Sudo

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 6/2011

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Abstract

Purpose

Correct alignment of the leg and positioning of the components are important factors in good long-term outcome of total knee arthroplasty (TKA). Computer-assisted navigation systems were introduced to improve component alignment accuracies. The three main hypotheses of this study were that the navigated compared to jig-based patient will show the following: (1) No difference in clinical outcomes. (2) Better alignment in the frontal and sagittal plane. (3) Better rotational positioning of components.

Methods

The authors evaluated 100 patients who had minimally invasive TKA using either an image-free computer-assisted navigation system (n = 50) or a jig-based technique (n = 50). Six months postoperatively, clinical and radiological evaluations were performed using full-length standing anteroposterior and lateral radiographs and CT scans of the knee.

Results

Knee Society knee score, function score, and range of motion were comparable in the two groups after surgery. The percentage of patients with a frontal tibiofemoral angle within ±3° of the ideal was significantly higher in the navigated group than in the jig-based group (94% vs. 78%, respectively; P = 0.041). No significant differences were found between groups in terms of the frontal and sagittal planes as well as rotational alignment of the femoral or tibial components.

Conclusion

Computer-assisted TKA gives a better correction of alignment of the leg compared with jig-based TKA when combined with a minimally invasive surgical approach.
Literatur
1.
Zurück zum Zitat Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89-A:261–269CrossRef Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89-A:261–269CrossRef
2.
Zurück zum Zitat Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86-B:682–687CrossRef Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86-B:682–687CrossRef
3.
Zurück zum Zitat Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47PubMed Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47PubMed
4.
Zurück zum Zitat Biasca N, Wirth S, Bungartz M (2009) Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee 16:22–29PubMedCrossRef Biasca N, Wirth S, Bungartz M (2009) Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee 16:22–29PubMedCrossRef
5.
Zurück zum Zitat Bonutti PM, Dethmers DA, McGrath MS, Ulrich SD, Mont MA (2008) Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res 466:2730–2735PubMedCrossRef Bonutti PM, Dethmers DA, McGrath MS, Ulrich SD, Mont MA (2008) Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res 466:2730–2735PubMedCrossRef
6.
Zurück zum Zitat Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA (2008) Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res; 466:2756–2762PubMedCrossRef Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA (2008) Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res; 466:2756–2762PubMedCrossRef
7.
Zurück zum Zitat Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86-B:372–377CrossRef Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86-B:372–377CrossRef
8.
Zurück zum Zitat Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20:618–626PubMedCrossRef Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20:618–626PubMedCrossRef
9.
Zurück zum Zitat Confalonieri N, Manzotti A, Pullen C, Ragone V (2007) Mini-incision versus mini-incision and computer-assisted surgery in total knee replacement: a radiological prospective randomised study. Knee 14:443–447PubMedCrossRef Confalonieri N, Manzotti A, Pullen C, Ragone V (2007) Mini-incision versus mini-incision and computer-assisted surgery in total knee replacement: a radiological prospective randomised study. Knee 14:443–447PubMedCrossRef
10.
Zurück zum Zitat Dalury DF, Dennis DA (2005) Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77–81PubMedCrossRef Dalury DF, Dennis DA (2005) Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77–81PubMedCrossRef
11.
Zurück zum Zitat Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20:618–626CrossRef Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20:618–626CrossRef
12.
Zurück zum Zitat Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 90-B:2–9CrossRef Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 90-B:2–9CrossRef
13.
Zurück zum Zitat Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159PubMedCrossRef Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159PubMedCrossRef
14.
Zurück zum Zitat Haas SB, Cook S, Beksac B (2004) Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 428:68–73PubMedCrossRef Haas SB, Cook S, Beksac B (2004) Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 428:68–73PubMedCrossRef
15.
Zurück zum Zitat Haas SB, Manitta MA, Burdick P (2006) Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop Relat Res 452:112–116PubMedCrossRef Haas SB, Manitta MA, Burdick P (2006) Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop Relat Res 452:112–116PubMedCrossRef
16.
Zurück zum Zitat Hvid I, Nielsen S (1984) Total condylar knee arthroplasty. Prosthetic component positioning and radiolucent lines. Acta Orthop Scand 55:160–165PubMedCrossRef Hvid I, Nielsen S (1984) Total condylar knee arthroplasty. Prosthetic component positioning and radiolucent lines. Acta Orthop Scand 55:160–165PubMedCrossRef
17.
Zurück zum Zitat Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
18.
Zurück zum Zitat Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73-B:709–714 Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73-B:709–714
19.
Zurück zum Zitat Jung HJ, Jung YB, Song KS, Park SJ, Lee JS (2007) Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am 89-A:2280–2284CrossRef Jung HJ, Jung YB, Song KS, Park SJ, Lee JS (2007) Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am 89-A:2280–2284CrossRef
20.
Zurück zum Zitat Kashyap SN, van Ommeren JW (2008) Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study. Knee Surg Sports Traumatol Arthrosc 16:544–548PubMedCrossRef Kashyap SN, van Ommeren JW (2008) Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study. Knee Surg Sports Traumatol Arthrosc 16:544–548PubMedCrossRef
21.
Zurück zum Zitat Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89-B:471–476CrossRef Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89-B:471–476CrossRef
22.
Zurück zum Zitat Kim YH, Kim JS, Choi Y, Kwon OR (2009) Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 91-A:14–19CrossRef Kim YH, Kim JS, Choi Y, Kwon OR (2009) Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 91-A:14–19CrossRef
23.
Zurück zum Zitat King J, Stamper DL, Schaad DC, Leopold SS (2007) Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty, Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 89-A:1497–1503CrossRef King J, Stamper DL, Schaad DC, Leopold SS (2007) Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty, Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 89-A:1497–1503CrossRef
24.
Zurück zum Zitat Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC et al (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81PubMedCrossRef Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC et al (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81PubMedCrossRef
25.
Zurück zum Zitat Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59-A:77–79 Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59-A:77–79
26.
Zurück zum Zitat Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M (2008) Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 16:928–934PubMedCrossRef Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M (2008) Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 16:928–934PubMedCrossRef
27.
Zurück zum Zitat Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90-B:1039–1044CrossRef Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90-B:1039–1044CrossRef
28.
Zurück zum Zitat Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22:1097–1106PubMedCrossRef Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22:1097–1106PubMedCrossRef
29.
Zurück zum Zitat Matsui Y, Kadoya Y, Uehara K, Kobayashi A, Takaoka K (2005) Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clin Orthop Relat Res 433:147–151PubMedCrossRef Matsui Y, Kadoya Y, Uehara K, Kobayashi A, Takaoka K (2005) Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clin Orthop Relat Res 433:147–151PubMedCrossRef
30.
Zurück zum Zitat Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89-A:236–243CrossRef Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89-A:236–243CrossRef
31.
Zurück zum Zitat Mizu-uchi H, Matsuda S, Miura H, Higaki H, Okazaki K, Iwamoto Y (2006) The effect of ankle rotation on cutting of the tibia in total knee arthroplasty. J Bone Joint Surg Am 88-A:2632–2636CrossRef Mizu-uchi H, Matsuda S, Miura H, Higaki H, Okazaki K, Iwamoto Y (2006) The effect of ankle rotation on cutting of the tibia in total knee arthroplasty. J Bone Joint Surg Am 88-A:2632–2636CrossRef
32.
Zurück zum Zitat Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y (2008) The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br 90-B:1025–1031CrossRef Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y (2008) The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br 90-B:1025–1031CrossRef
33.
Zurück zum Zitat Novak EJ, Silverstein MD, Bozic KJ (2007) The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 89-A:2389–2397CrossRef Novak EJ, Silverstein MD, Bozic KJ (2007) The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 89-A:2389–2397CrossRef
34.
Zurück zum Zitat Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64PubMed Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64PubMed
35.
Zurück zum Zitat Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173PubMed Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173PubMed
36.
Zurück zum Zitat Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:249–257PubMedCrossRef Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:249–257PubMedCrossRef
37.
Zurück zum Zitat Seon JK, Song EK (2006) Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty 21:777–782PubMedCrossRef Seon JK, Song EK (2006) Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty 21:777–782PubMedCrossRef
38.
Zurück zum Zitat Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG (2007) Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg 12:189–193PubMed Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG (2007) Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg 12:189–193PubMed
39.
Zurück zum Zitat Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87-A:2276–2280CrossRef Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87-A:2276–2280CrossRef
40.
Zurück zum Zitat Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69PubMedCrossRef Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69PubMedCrossRef
41.
Zurück zum Zitat Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835PubMed Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835PubMed
42.
Zurück zum Zitat Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89-A:477–480 Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89-A:477–480
43.
Zurück zum Zitat Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186PubMedCrossRef Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186PubMedCrossRef
44.
Zurück zum Zitat Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98PubMed Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98PubMed
45.
Zurück zum Zitat Stulberg SD, Yaffe MA, Koo SS (2006) Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88-A(Suppl 4):47–54CrossRef Stulberg SD, Yaffe MA, Koo SS (2006) Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88-A(Suppl 4):47–54CrossRef
46.
Zurück zum Zitat Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190PubMedCrossRef Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190PubMedCrossRef
Metadaten
Titel
Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome
verfasst von
Masahiro Hasegawa
Kakunoshin Yoshida
Hiroki Wakabayashi
Akihiro Sudo
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 6/2011
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1253-7

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