Computer navigation for total knee arthroplasty achieves better postoperative alignment compared to conventional and patient-specific instrumentation in a low-volume setting - 29/10/18
, Ulrich Lueke, Timo Stuebig, Nael Hawi, Christian Krettek, Emmanouil Liodakis
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
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Abstract |
Background |
Procedure volume is an important determinant of total knee arthroplasty (TKA) outcomes. We aimed to determine whether computer navigation or patient-specific instrumentation (PSI) would improve postoperative alignment in a low-volume setting.
Hypothesis |
PSI for TKA achieves better limb and implant alignment compared to conventional TKA and to computer navigated TKA.
Materials and methods |
This is a retrospective cohort study of 385 primary TKAs (Women=59%. Mean age=67years. Mean BMI=30.1kg/m2), which were performed using conventional instrumentation (n=117; 30%), computer navigation (n=209; 54%), or patient-specific instrumentation (n=59; 15%) in a low-volume center (<50 TKAs/year). The risk of postoperative leg and implant mechanical alignment outliers in the coronal plane (>3° from neutral), average alignment and operation time were assessed.
Results |
The risk of postoperative mechanical alignment outliers (>3°) was reduced by 89% in the navigated group (4% outliers) compared to the conventional group (35%) (RR=0.11; p<0.0001). No significant improvement was observed in the PSI group (27%) (RR=0.91; p=0.772). The risk of postoperative femoral component coronal alignment outliers was reduced by 63% in the navigated group (11%) compared to the conventional group (31%) (RR=0.37; p=0.018). No significant reduction in outliers was observed in the PSI group (32%) (RR=1.08; p=0.816). There was a reduction in the risk of tibial component coronal malalignment of 66% in the navigated group (5%) compared to the conventional group (13%) (RR=0.33; p=0.070). There was a two-fold increase in the risk of tibial component alignment outliers in the PSI group (29%) (RR=1.94; p=0.110).
Discussion |
Computer navigation improved postoperative alignment in TKA. No evidence of improved alignment was seen with patient-specific instrumentation. The routine use of patient-specific instrumentation in low-volume centers is not supported by the currently available data.
Type of study |
Retrospective cohort study. Level IV.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Knee, Total knee Arthroplasty, Patient-specific TKA, Computer navigation, Low-volume, Alignment
Mappa
Vol 104 - N° 7
P. 971-975 - novembre 2018 Ritorno al numero
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Benvenuto su EM|consulte, il riferimento dei professionisti della salute.