J Korean Orthop Assoc.  2012 Oct;47(5):344-352. 10.4055/jkoa.2012.47.5.344.

Comparison of Results of Total Knee Arthroplasty Performed Using the Navigation System and the Conventional Technique: Minimal Follow-Up of 5 Years

• Cho HJ
• Seon JK
• Yim JH
• Oh CS
• Song EK

• KMID: 2185318
• DOI: http://doi.org/10.4055/jkoa.2012.47.5.344

Abstract

PURPOSE
Authors compared the laxity, radiologic and clinical outcomes of total knee arthroplasty (TKA) performed using the navigation system and using the conventional technique at least 5-year follow-up.
MATERIALS AND METHODS
Total of 92 TKAs were included for this study. Forty seven TKAs were performed by the navigation group and 45 TKAs were performed by the conventional surgery. At the final follow up, to evaluate knee joint laxity, varus-valgus laxities were measured on the stress radiographs taken with varus or valgus loads at 90degrees of flexion. The radiologic measurements and the clinical evaluations were compared between two groups.
RESULTS
At the final follow-up, the mean of valgus laxities were 3.9degrees in the navigation group and 4.0degrees in the conventional group, and the corresponding mean of varus laxities were 4.0degrees and 4.3degrees (p=0.19, p=0.22) at 90degrees flexion state. Although there was no significant difference in the total laxities (7.8degrees in the navigation group and 8.1degrees in the conventional group, p=0.35). However, more than 10degrees of total laxity was significantly reduced in the navigation group (1 knee in the navigation group and 6 knees in the conventional group, p=0.04). The outlier numbers at mechanical axis, the mean of coronal inclination of the femoral and tibial component and the mean of sagittal inclination of the femoral and tibial component in the two groups were significantly different. Stiffness of WOMAC score was significantly better in the navigation than in the conventional group (p<0.001).
CONCLUSION
Varus-valgus laxity was significantly different in the two groups as were the outlier numbers. The navigation system could provide good, improved alignment accuracy of the lower extremity and better result in stiffness of knee compared with conventional technique.

Keyword

knee; arthroplasty; navigation

MeSH Terms

Arthroplasty
Axis, Cervical Vertebra
Follow-Up Studies
Knee
Knee Joint
Lower Extremity

Figure

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  Figure 1 (A) The patients sat on a radiolucent wooden table with their legs hanging over the edge, the knee flexed at 90° with relaxed muscles and touching the vertical cassette stand. The central X-ray beam was aimed from behind the sitting patient in an upward angle of 10-15° into the center of the patella with a film-focus distance of one meter. (B) Valgus or varus force with spring scale (50 N) at 30 cm distal from joint was induced. (C) The joint opening angle between a tangent to the distal femoral condyles and a line between medial and lateral tibial plateaus was measured.

• 

  Figure 2 The mechanical axis (θ) of leg is the angle formed between the femoral axis and tibial axis. A (white line), femoral axis; B (black line), tibial axis.

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  Figure 3 Postoperative measurement of the femoral and tibial components. (A) α: The inclination angle of the femoral component was formed with the mechanical axis of the femur. (B) β: The inclination angle of the tibial component was formed with the mechanical axis of the tibia. (C) γ: The angle of the femoral component was formed between the anatomical axis of the femur and perpendicular line to the prosthesis. δ: The angle of the tibial component was formed with the mechanical axis of the tibia.

• 

  Figure 4 (A) Posterior femoral offset D was defined as the distance between the posterior femoral cortical margin and the posterior margins of the femoral condyles. (B) Postoperative posterior femoral offset D' was defined as the distance between the posterior femoral margin and the posterior margins of the femoral implant condyles.

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