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Erschienen in: MUSCULOSKELETAL SURGERY 1/2017

03.12.2016 | Original Article

Long-term functional outcomes and knee alignment of computer-assisted navigated total knee arthroplasty

verfasst von: V. Sardana, J. M. Burzynski, M. Khan, N. Stone, B. S. Weening, P. K. Zalzal

Erschienen in: MUSCULOSKELETAL SURGERY | Ausgabe 1/2017

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Abstract

Introduction

This retrospective study examined the relationship between the mechanical axis throughout a functional arc of motion and functional outcome scores in patients undergoing computer-assisted navigation-based total knee arthroplasty (CAN-TKA) at 6-year follow-up.

Materials and methods

The Stryker eNact Precision Knee Navigation System was utilized to obtain pre- and postoperative alignment measurements throughout the functional arc of motion. Patients were contacted via telephone and asked to complete the Short Form-12 and Western Ontario and McMaster Universities, which have been demonstrated to be reliable, valid, and sensitive assessment tools in this patient population. Statistical analysis was performed to determine the correlation between arc alignment and patient-reported functional outcome measures.

Results

A total of 47 patients at a mean of 76.1 (±6.3)-month follow-up and mean age of 65.9 (±7.9) years were surveyed. No correlation was found between the postoperative alignment or degree of intraoperative correction and the functional outcome scores. In a planned subgroup analysis of patients with a mean functional arc alignment greater than 3° from neutral, mean intraoperative degree of correction correlated with decreasing physical function (Spearman’s ρ = 0.772, p = 0.04) and mean postoperative arc alignment positively correlated with increasing stiffness (ρ = 0.798, p = 0.03).

Conclusion

This study suggests that patients undergoing CAN-TKA with mean functional arc range of motion greater than 3° may be at increased risk for suboptimal patient-reported functional outcomes. This study also illustrates the ability of CAN-TKA to measure the varus or valgus alignment of the knee throughout the entire range of motion.
Literatur
1.
Zurück zum Zitat Berger RA, Rosenberg AG, Barden RM, Sheinkop MB, Jacobs JJ, Galante JO (2001) Long-term follow-up of the Miller-Galante total knee replacement. Clin Orthop Relat Res 388:58–67CrossRef Berger RA, Rosenberg AG, Barden RM, Sheinkop MB, Jacobs JJ, Galante JO (2001) Long-term follow-up of the Miller-Galante total knee replacement. Clin Orthop Relat Res 388:58–67CrossRef
2.
Zurück zum Zitat Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish knee arthroplasty register 1975–1997: an update with special emphasis on 41,223 knees operated on from 1988 to 1997. Acta Orthop Scand 72(5):503–513CrossRefPubMed Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish knee arthroplasty register 1975–1997: an update with special emphasis on 41,223 knees operated on from 1988 to 1997. Acta Orthop Scand 72(5):503–513CrossRefPubMed
3.
Zurück zum Zitat Keating EM, Meding JB, Faris PM, Ritter MA (2002) Long-term follow-up of nonmodular total knee replacements. Clin Orthop Relat Res 404:34–39CrossRef Keating EM, Meding JB, Faris PM, Ritter MA (2002) Long-term follow-up of nonmodular total knee replacements. Clin Orthop Relat Res 404:34–39CrossRef
4.
Zurück zum Zitat Bozic KJ, Kurtz SM, Lau E et al (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468(1):45–51CrossRefPubMed Bozic KJ, Kurtz SM, Lau E et al (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468(1):45–51CrossRefPubMed
6.
Zurück zum Zitat Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173 Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173
7.
Zurück zum Zitat Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY (2004) Healthrelated quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974CrossRefPubMed Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY (2004) Healthrelated quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974CrossRefPubMed
8.
Zurück zum Zitat Gill GS, Joshi AB, Mills DM (1999) Total condylar knee arthroplasty. 16- to 21-year results. Clin Orthop Relat Res 367:210–215CrossRef Gill GS, Joshi AB, Mills DM (1999) Total condylar knee arthroplasty. 16- to 21-year results. Clin Orthop Relat Res 367:210–215CrossRef
9.
Zurück zum Zitat Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ (1993) Longterm results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop Relat Res 286:94–102 Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ (1993) Longterm results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop Relat Res 286:94–102
10.
Zurück zum Zitat Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373(17):1597–1606CrossRefPubMed Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373(17):1597–1606CrossRefPubMed
11.
Zurück zum Zitat Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467(10):2606–2612CrossRefPubMedPubMedCentral Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467(10):2606–2612CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Siston RA, Giori NJ, Goodman SB, Delp SL (2007) Surgical navigation for total knee arthroplasty: a perspective. J Biomech 40:728–735CrossRefPubMed Siston RA, Giori NJ, Goodman SB, Delp SL (2007) Surgical navigation for total knee arthroplasty: a perspective. J Biomech 40:728–735CrossRefPubMed
13.
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(8):1097–1106CrossRefPubMed 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(8):1097–1106CrossRefPubMed
14.
Zurück zum Zitat Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop Relat Res 205:5 Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop Relat Res 205:5
15.
Zurück zum Zitat Hofmann AA, Bachus KN, Wyatt RW (1991) Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop Relat Res 269:63 Hofmann AA, Bachus KN, Wyatt RW (1991) Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop Relat Res 269:63
16.
Zurück zum Zitat Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49 Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49
17.
Zurück zum Zitat Matziolis G, Krocker D, Weiss U et al (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 89:236PubMed Matziolis G, Krocker D, Weiss U et al (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 89:236PubMed
18.
Zurück zum Zitat Ritter MA, Herbst SA, Keating EM et al (1994) Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 309:136 Ritter MA, Herbst SA, Keating EM et al (1994) Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 309:136
19.
Zurück zum Zitat Bonner TJ, Eardley WGP, Patterson P et al (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217CrossRefPubMed Bonner TJ, Eardley WGP, Patterson P et al (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217CrossRefPubMed
20.
Zurück zum Zitat Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24(Suppl):39CrossRefPubMed Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24(Suppl):39CrossRefPubMed
21.
Zurück zum Zitat Parratte S, Pagnano MW, Trousdale RT et al (2010) Effect of postoperative mechanical axis alignment in the 15-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92:2143CrossRefPubMed Parratte S, Pagnano MW, Trousdale RT et al (2010) Effect of postoperative mechanical axis alignment in the 15-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92:2143CrossRefPubMed
22.
Zurück zum Zitat Dong H, Coyle D, Buxton M (2007) Value of information analysis for a new technology: computer-assisted total knee replacement. Int J Technol Assess Health Care 23:337–342CrossRefPubMed Dong H, Coyle D, Buxton M (2007) Value of information analysis for a new technology: computer-assisted total knee replacement. Int J Technol Assess Health Care 23:337–342CrossRefPubMed
23.
Zurück zum Zitat Hsu WH, Hsu RW, Weng YJ (2010) Effect of preoperative deformity on postoperative leg axis in total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18(10):1323CrossRefPubMed Hsu WH, Hsu RW, Weng YJ (2010) Effect of preoperative deformity on postoperative leg axis in total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18(10):1323CrossRefPubMed
24.
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, randomized study. J Bone Joint Surg 89(4):471CrossRef Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomized study. J Bone Joint Surg 89(4):471CrossRef
25.
Zurück zum Zitat Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation versus conventional total knee arthroplasty. J Arthroplasty 27(6):1177–1182CrossRefPubMed Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation versus conventional total knee arthroplasty. J Arthroplasty 27(6):1177–1182CrossRefPubMed
26.
Zurück zum Zitat Khan MM, Khan MW, Al-Harbi HH, Weening BS, Zalzal PK (2012) Assessing short-term functional outcomes and knee alignment of computer-assisted navigated total knee arthroplasty. J Arthroplasty 27(2):271–277CrossRefPubMed Khan MM, Khan MW, Al-Harbi HH, Weening BS, Zalzal PK (2012) Assessing short-term functional outcomes and knee alignment of computer-assisted navigated total knee arthroplasty. J Arthroplasty 27(2):271–277CrossRefPubMed
28.
Zurück zum Zitat Ware JE, Kosinski M, Turner-Bowker DM et al (2002) User’s manual for the SF-12v2 health survey with a supplement documenting SF-12 health survey. Quality-Metric Incorporated, Lincoln, RI Ware JE, Kosinski M, Turner-Bowker DM et al (2002) User’s manual for the SF-12v2 health survey with a supplement documenting SF-12 health survey. Quality-Metric Incorporated, Lincoln, RI
29.
Zurück zum Zitat Browne JA, Cook C, Hofmann AA, Bolognesi MP (2010) Postoperative morbidity and mortality following total knee arthroplasty with computer navigation. Knee 17(2):152–156CrossRefPubMed Browne JA, Cook C, Hofmann AA, Bolognesi MP (2010) Postoperative morbidity and mortality following total knee arthroplasty with computer navigation. Knee 17(2):152–156CrossRefPubMed
30.
Zurück zum Zitat Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156 Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156
31.
Zurück zum Zitat Vince KG, Insall JN, Kelly MA (1989) The total condylar prosthesis. 10- to 12-year results of a cemented knee replacement. J Bone Joint Surg Br 71(5):793–797CrossRefPubMed Vince KG, Insall JN, Kelly MA (1989) The total condylar prosthesis. 10- to 12-year results of a cemented knee replacement. J Bone Joint Surg Br 71(5):793–797CrossRefPubMed
32.
Zurück zum Zitat Cobb JP, Kannan V, Brust K, Thevendran G (2007) Navigation reduces the learning curve in resurfacing total hip arthroplasty. Clin Orthop Relat Res 463:90–97PubMed Cobb JP, Kannan V, Brust K, Thevendran G (2007) Navigation reduces the learning curve in resurfacing total hip arthroplasty. Clin Orthop Relat Res 463:90–97PubMed
33.
Zurück zum Zitat Jenny JY, Mielke RK, Giurea A (2008) Learning curve in navigated total knee replacement: a multi-centre study comparing experienced and beginner centers. Knee 15(2):80–84CrossRefPubMed Jenny JY, Mielke RK, Giurea A (2008) Learning curve in navigated total knee replacement: a multi-centre study comparing experienced and beginner centers. Knee 15(2):80–84CrossRefPubMed
34.
Zurück zum Zitat Yau WP, Chiu KY, Zuo JL, Tang WM, Ng TP (2008) Computer navigation did not improve alignment in a lower-volume total knee practice. Clin Orthop Relat Res 466(4):935–945CrossRefPubMedPubMedCentral Yau WP, Chiu KY, Zuo JL, Tang WM, Ng TP (2008) Computer navigation did not improve alignment in a lower-volume total knee practice. Clin Orthop Relat Res 466(4):935–945CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Daubresse F, Vajeu C, Loquet R (2005) Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital. Acta Orthop Belg 71(6):710–713PubMed Daubresse F, Vajeu C, Loquet R (2005) Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital. Acta Orthop Belg 71(6):710–713PubMed
36.
Zurück zum Zitat Shi J, Wei Y, Wang S, Chen F, Wu J, Huang G, Chen J, Wei L, Xia J (2014) Computer navigation and total knee arthroplasty. Orthopedics 37(1):e39–e43CrossRefPubMed Shi J, Wei Y, Wang S, Chen F, Wu J, Huang G, Chen J, Wei L, Xia J (2014) Computer navigation and total knee arthroplasty. Orthopedics 37(1):e39–e43CrossRefPubMed
38.
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(11):2756–2762CrossRefPubMedPubMedCentral 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(11):2756–2762CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty 26(3):504–508CrossRefPubMed Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty 26(3):504–508CrossRefPubMed
40.
Zurück zum Zitat Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138CrossRefPubMed Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138CrossRefPubMed
41.
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 433:152–159CrossRef 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 433:152–159CrossRef
42.
Zurück zum Zitat Berend ME (2009) Computer-assisted TKA: greater precision, doubtful clinical efficacy: affirms. Orthopedics 32(9):24 Berend ME (2009) Computer-assisted TKA: greater precision, doubtful clinical efficacy: affirms. Orthopedics 32(9):24
Metadaten
Titel
Long-term functional outcomes and knee alignment of computer-assisted navigated total knee arthroplasty
verfasst von
V. Sardana
J. M. Burzynski
M. Khan
N. Stone
B. S. Weening
P. K. Zalzal
Publikationsdatum
03.12.2016
Verlag
Springer Milan
Erschienen in
MUSCULOSKELETAL SURGERY / Ausgabe 1/2017
Print ISSN: 2035-5106
Elektronische ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-016-0442-z

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