0
Scientific Articles   |    
Computer-Assisted Surgical Navigation Does Not Improve the Alignment and Orientation of the Components in Total Knee Arthroplasty
Young-Hoo Kim, MD1; Jun-Shik Kim, MD1; Yoowang Choi, MD1; Oh-Ryong Kwon, MD1
1 The Joint Replacement Center of Korea at Ewha Womans University, Mok Dong Hospital, 911-1, MokDong, YangCheon-Ku, Seoul 158-710, South Korea. E-mail address for Y.-H. Kim: younghookim@ewha.ac.kr
View Disclosures and Other Information
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.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).
Investigation performed at The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, Seoul, South Korea

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jan 01;91(1):14-19. doi: 10.2106/JBJS.G.01700
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Whether total knee arthroplasty with use of computer-assisted surgical navigation can improve the limb and component alignment is a matter of debate. We hypothesized that total knee arthroplasty with use of computer-assisted surgical navigation is superior to conventional total knee arthroplasty with regard to the precision of implant positioning.

Methods: Sequential simultaneous bilateral total knee arthroplasties were carried out in 160 patients (320 knees). One knee was replaced with use of a computer-assisted surgical navigation system, and the other was replaced conventionally without use of computer-assisted surgical navigation. The two methods were compared for accuracy of orientation and alignment of the components as determined by radiographs and computed tomography scans. The mean duration of follow-up was 3.4 years.

Results: The mean preoperative Knee Society score was 26 points, with an improvement to 92 points postoperatively, in the computer-assisted total knee arthroplasty group and 25 points, with an improvement to 93 points postoperatively, in the conventional total knee arthroplasty group. Preoperative and postoperative ranges of motion of the knees were similar in both groups. The operating and tourniquet times were significantly longer in the computer-assisted total knee arthroplasty group than in the conventional total knee arthroplasty group (p < 0.001). The groups were not significantly different with regard to the accuracy of component positioning and the number of outliers for the various radiographic parameters (p > 0.05).

Conclusions: Our data demonstrate that total knee arthroplasty with use of computer-assisted surgical navigation did not result in more accurate implant positioning than that achieved in conventional total knee arthroplasty, as determined by both radiographs and computed tomography scans.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Young-Hoo Kim, MD
    Posted on April 15, 2009
    Dr. Kim and colleagues respond to Drs. Ferretti and Conteduca
    Ewha Womans University School of Medicine

    Thank you for your interest in our recent article (1). You are correct in stating that since we did not navigate the rotational alignment of the tibial competent, the rotational deviation and the incidence of outliers of the tibial component between the two groups were similar.

    Although there was a tendency to have a better alignment in both coronal and sagittal planes in the navigated group, these differences were not significant between the two groups (P > 0.05). Furthermore, we believe that these marginal differences are not clinically meaningful.

    Therefore, we believe the title of the paper is appropriate and the conclusions are fully justified by the results.

    Reference

    1. Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14-9.

    Andrea Ferretti, MD
    Posted on April 11, 2009
    Computer-Assisted Surgical Navigation Does Not Improve the Alignment and Orientation of the...
    Orthopaedic Department Sant'Andrea Uniuversity Hospital, Rome, Italy

    To the Editor:

    We congratulate Dr. Young-Hoo Kim and co-authors for studying this important topic (1), but we question whether their conclusions are actually supported by the data. After a careful reading of the paper, we have two concerns that we would like to share with the authors.

    The first concern is about rotational alignment. The authors did not provide details about the ability of the system used in their study to actually navigate the rotation of the tibial implant. As the majority of the navigation systems currently in use do not allow navigation of the rotation of the tibial insert, the lack of difference in this parameter between standard and CAOS is not surprising.

    The second, and more important concern, is about the reported results of coronal and sagittal alignment of the two groups. In analyzing all of the radiographic parameters, as shown in Table III, all the results in the CAOS group are much better when compared to the standard group, with a difference ranging from about 40% (outliers > 3° in tibial sagittal plane) to 100% (outliers > 3° in tibial coronal plane). Even if the differences are not statistically significant according to the statistical method used, the results seem to indicate a strong trend in favor of the CAOS, at least in the radiographic results and in the accuracy of the implant positioning.

    Therefore, we believe the title of the paper is misleading and that the conclusions are too strong and not fully justified by the results.

    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.

    Reference

    1. Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14-9.

    Young-Hoo Kim, MD
    Posted on March 26, 2009
    Dr. Kim and colleagues respond to Dr. Matziolis and Mr. Perka
    Ewha Womans University School of Medicine, Seoul, South Korea

    We thank Drs. Matziolis and Perka for their interest in our recent article(1). We acknowledge errors in our Table E-1 for the outliers in the sagittal (9 navigated vs 24 conventional) and the coronal plane (15 navigated vs 27 conventional). "9 of 160 knees (6%)" should be corrected to, "16 of 160 knees (10%)". Also, "27 of 160 knees (17%)" should be corrected to, "25 of 160 knees (16%)". We did not notice these errors when we submitted the manuscript or on the galley proofs.

    The precision of the hip center may be different when comparing different navigation systems. Our previously published data (2) using the Vector Vision CT- free knee (Brain LAB, Munich, Germany) and another previous unpublished data using Ci Version CT-free knee (Brain LAB, Munich, Germany) revealed similar results to those of the current study.

    References

    1. Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14-9.

    2. Kim YH, Kim JS, Yoon SH. Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br. 2007;89:471-6.

    Georg Matziolis
    Posted on March 02, 2009
    Computer Assisted Surgical Navigation for Total Knee Arthroplasty
    Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - University Hospital Berlin

    To the Editor:

    I read with interest the paper by Kim et al. (1) in which the authors address the ongoing controversy about the role of navigation in total knee arthroplasty(TKA). Although the number of patients included in the study seems sufficient, I believe that their conclusion that the use of navigation does not result in more accurate implant positioning is not supported by their results.

    The data presented in Table E-1 for the tibial outliers in the sagittal (9 navigated vs. 24 conventional) and the coronal plane (15 navigated vs. 27 conventional) show a significant difference in the X² test (p=0.006 for the coronal plane and p=0.047 for the sagittal plane). Although navigated as well as conventional tibial component positioning is based on extramedullary bone landmarks, the computer assistance significantly reduced outliers in both planes.

    Regarding the femoral component, the precision with which the hip center is determined is crucial for determining the optimal femoral alignment. Finding the hip center depends on the mathematical algorithm used by each specific navigation system and differs between the systems and even different software versions of the same system. Therefore the conclusion about navigated femoral alignment precision should not be generalized to all navigation systems.

    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.

    Reference

    1. Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14-9.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    04/16/2014
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)