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Computer-assisted versus intramedullary and extramedullary alignment system in total knee replacement: Long term follow-up.

ABSTRACT: Introduction:The aim of this work is to compare in a retrospective study, the radiological results of three series of different total knee replacements performed using Orthopilot computer-based alignment system (Group A, 31 patients), a totally intramedullary alignment system (Group B, 34 patients) and a totally extramedullary alignment system (Group C, 32 patients). Materials and methods:At a medium follow-up of 15 years, all patients underwent call interview for clinical update. Of the 115 patients initially enrolled in the study, only 97 were available for radiological assessment. Both standing long-leg antero-posterior radiographs and lateral radiographs of the knee had been taken for every patient at 1 year-follow-up and at the last follow-up. Results:At the last follow-up, the mean hip-knee-ankle angle (HKA) was 179.1° (range: 176°-184°) for group A, 178.6° (range: 173°-186°) for group B and 177.8° (range: 172°-186°) for group C with no statistically significant difference among the 3 groups. The mean frontal femoral component angle (FFC) was 90.5° (range: 87°-94°) for group A, 91.05° (range: 85°-95°) for group B and 91.19° (range: 85°-96°) for group C and there was no statistically significant difference among the three groups. The mean frontal tibial component angle (FTC) was 89.9° (range: 83°-97°) for group A, 90.6° (range: 87°-95°) for group B and 90.8° (range: 86°-95°) for group C and there was no statistically significant difference among the three groups. The mean tibial component inclination in the sagittal plane was 1° (range: 3°-0°) for group A, 3.6° (range: 7°-0°) for group B and 3.1° (range: 6°-0°) for group C. Discussion and conclusion:Our results demonstrated statistically significant differences between computer-assisted and extramedullary group, in favour of navigated group in terms of implant position and mechanical alignment. Computer-assisted group showed superior but not statistically significant differences compared to intramedullary alignment system in terms of implant position and mechanical alignment. We advocate the use of computer-assisted system routinely in total knee replacement. As an alternative, we suggest the use of intramedullary system.

SUBMITTER: A B

PROVIDER: S-EPMC6494757 | biostudies-literature | 2019 May-Jun

REPOSITORIES: biostudies-literature

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Computer-assisted versus intramedullary and extramedullary alignment system in total knee replacement: Long term follow-up.

A Biazzo B A Manzotti M N Confalonieri C

Journal of clinical orthopaedics and trauma 20180705 3

<h4>Introduction</h4>The aim of this work is to compare in a retrospective study, the radiological results of three series of different total knee replacements performed using Orthopilot computer-based alignment system (Group A, 31 patients), a totally intramedullary alignment system (Group B, 34 patients) and a totally extramedullary alignment system (Group C, 32 patients).<h4>Materials and methods</h4>At a medium follow-up of 15 years, all patients underwent call interview for clinical update. ...[more]

PMID: 31061589

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Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

Dataset Information

Computer-assisted versus intramedullary and extramedullary alignment system in total knee replacement: Long term follow-up.

Publications

Computer-assisted versus intramedullary and extramedullary alignment system in total knee replacement: Long term follow-up.

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