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Scientific Articles   |    
Alignment Deviation Between Bone Resection and Final Implant Positioning in Computer-Navigated Total Knee Arthroplasty
Fabio Catani, MD1; Nicola Biasca, MD2; Andrea Ensini, MD1; Alberto Leardini, PhD1; Luca Bianchi, MD1; Vitantonio Digennaro, MD1; Sandro Giannini, MD1
1 Movement Analysis Laboratory (F.C., A.E., A.L., and S.G.) and the Department of Orthopaedic Surgery (F.C., A.E., L.B., V.D., and S.G.), Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy. E-mail address for A. Ensini: andrea.ensini@ior.it
2 Department of Orthopaedic Surgery, Spital Oberengandin, CH 7503 Samedan, Switzerland
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery and Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy, and the Department of Orthopaedic Surgery, Spital Oberengandin, Samedan, Switzerland

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Apr 01;90(4):765-771. doi: 10.2106/JBJS.G.00293
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Abstract

Background: Computer-navigated total knee arthroplasty is aimed at improving accuracy in the positioning of prosthetic components and realigning the lower limb. The optimal position and orientation of the bone resection planes are targeted by the navigation system, but, after these are obtained, additional manual surgical actions, which may considerably affect final component alignment, are necessary for implantation. The aim of this study was to measure the alignment deviation caused by standard impaction of the tibial and femoral components following bone resections with use of navigation control.

Methods: Ninety-one primary total knee arthroplasties were performed with an image-free knee navigation system. The alignment of the tibial and femoral bone resections was measured in three planes during surgery by the instrumented probe of the system. The alignment measure was repeated after final tibial and femoral component implantation with cement. The alignment deviations between the two measures were considered the positioning error associated with the final manual implantation of the components.

Results: The alignment deviations between the bone resections and the subsequent implant placement were >1° in the frontal plane of the femur and in the frontal and sagittal planes of the tibia in 20%, 11%, and 33% of the patients, respectively. The deviations were >2° in 4%, 3%, and 9% of the patients, respectively. Deviations as large as 3° were found at the tibia in the sagittal plane (the posterior slope).

Conclusions: Positioning of the femoral and tibial components in total knee arthroplasty, which mainly involves cementation and impaction of the final components, can introduce a considerable error in alignment, regardless of how accurately the resection planes are made. After computer-navigated total knee arthroplasty, it would be useful therefore to check the alignment of the prosthetic component carefully before the cement hardens.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    ANDREA ENSINI
    Posted on September 15, 2008
    Dr. Ensini and colleagues respond to Dr. Sikorski
    Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli

    We deeply regret not having realized that the paper by Sikorski et al.(1) reported rather similar work long before our study, despite our conscientious review of the literature. As partial justification we would like to say that it would have been very difficult to identify the type of work and results from the title of that paper, and impossible from the Abstract, since it was not available with the paper.

    As an example, a query in PudMed today with the keywords "computer-assisted total knee replacement", returns a list of 41 reviews and 424 papers overall.

    However, we would like to thank the authors for bringing this oversight to our attention and we will certainly cite their important work(1)in any future similar studies.

    References:

    1. Sikorski JM, Blythe MC. Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br 2005;87-7:903-10.)

    Jerzy M Sikorski
    Posted on August 04, 2008
    Acknowledgement of prior publication
    Hollywood Privat Hospital, Perth, Australia

    To the Editor:

    We were pleased to read this article and agree with its content and conclusions. We were, however, disappointed that our article, (Sikorski JM, Blythe MC. Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br 2005;87-7:903-10.) was not quoted as it reported similar work and results three years earlier.

    The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker South Pacific). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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