TITLE

Navigated Total Knee Replacement

AUTHOR(S)
Bauwens, Kai; Matthes, Gerrit; Wich, Michael; Gebhard, Florian; Hanson, Beate; Ekkernkamp, Axel; Stengel, Dirk
PUB. DATE
February 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p261
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Proponents of navigated knee arthroplasty stress its potential to increase the precision of component placement. We conducted a systematic review and meta-analysis to substantiate the validity and relevance of this contention. Methods: We searched major medical and publishers' databases for randomized trials and any other studies comparing navigated with conventional knee arthroplasty. Major periodicals were searched manually. We made no restrictions for types of studies or language. Methodological features were rated independently by two reviewers. After testing for publication bias and heterogeneity was done, the data were aggregated by random-effects modeling. We estimated the weighted mean differences of mechanical limb axes and functional scales and the risk ratios of deviations from the straight axis with 95% confidence intervals. Results: We included thirty-three studies (eleven randomized trials) of varying methodological quality involving 3423 patients with a mean age (and standard deviation) of 67.3 ± 4.1 years (62.6% were women, and 83.7% had primary osteoarthritis). The mean preoperative deviation from the mechanical axis was 2.3° ± 5.1°. There was no evidence of publication bias, but there was strong statistical heterogeneity. The alignment of the mechanical axes did not differ between the navigated and conventional surgery group (weighted mean difference, 0.2°; 95% confidence interval, -0.2° to 0.5°). Patients managed with navigated surgery had a lower risk of malalignment at critical thresholds of >3° (risk ratio, 0.79; 95% confidence interval, 0.71 to 0.87) and >2° (risk ratio, 0.76; 95% confidence interval, 0.71 to 0.82). No conclusive inferences could be drawn on functional outcomes or complication rates. Navigation lengthened the mean duration of surgery by 23%. Conclusions: Navigated knee replacement provides few advantages over conventional surgery on the basis of radiographic end points. Its clinical benefits are unclear and remain to be defined on a larger scale.
ACCESSION #
23964950

 

Related Articles

  • Manipulation After Total Knee Arthroplasty. Keating, E. Michael; Ritter, Merrill A.; Harty, Leesa D.; Haas, Gail; Meding, John B.; Fans, Philip M.; Berend, Michael E. // Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p282 

    Background: Following total knee arthroplasty, some patients who fail to achieve >90° of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total...

  • Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Malviya, Ajay; Lingard, E.; Weir, D.; Deehan, D. // Knee Surgery, Sports Traumatology, Arthroscopy;Jul2009, Vol. 17 Issue 5, p491 

    We have attempted to quantify the influence of clinical, radiological and prosthetic design factors upon flexion following knee replacement. Our study examined the outcome following 101 knee replacements performed in two prospective randomized trials using similar cruciate retaining implants....

  • The femoral sulcus in total knee arthroplasty. Lingaraj, Krishna; Bartlett, John // Knee Surgery, Sports Traumatology, Arthroscopy;Jul2009, Vol. 17 Issue 5, p499 

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native...

  • Sagittal laxity in vivo after total knee arthroplasty. Ishii, Yoshinori; Matsuda, Yoshikazu; Ishii, Ryo; Sakata, Shigeo; Omori, Go // Archives of Orthopaedic & Trauma Surgery;May2005, Vol. 125 Issue 4, p249 

    Introduction A stress arthrometry study of 77 knees undergoing total knee arthroplasty was performed to determine the difference in anteroposterior (AP) laxity between posterior cruciate ligament (PCL)-retaining (PCLR) and PCL-substituting (PCLS) prostheses using the Genesis I TKA. Materials and...

  • Total knee replacement and health-related quality of life: factors influencing long-term outcomes.  // International Journal of Advances in Rheumatology;2009, Vol. 7 Issue 4, p129 

    Is total knee replacement (TKR) for osteoarthritis equally effective in all patients? This Spanish group prospectively followed TKR patients and confirmed that the procedure conferred substantial benefit across the board; however, the gains were reduced in patients who were female or obese.

  • Subvastus Approach for Total Knee Arthroplasty. Gore, Donald R.; Sellinger, D. Scott; Gassner, Kevin J.; Glaeser, Scott T. // Orthopedics;Jan2003, Vol. 26 Issue 1, p33 

    Provides information on a study that described and illustrated the steps in the subvastus approach to total knee arthroplasty. Reason the approach has been criticized; Methodology of the study; Discussion of the study.

  • Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Dae-Hee Lee; Jong-Hoon Park; Dong-Ik Song; Debabrata Padhy; Woong-Kyo Jeong; Seung-Beom Han // Knee Surgery, Sports Traumatology, Arthroscopy;Mar2010, Vol. 18 Issue 3, p381 

    Equalized rectangular extension and flexion gaps are considered desirable to ensure proper kinematics in total knee arthroplasty (TKA). We compared soft tissue balancing in TKAs performed using navigation-assisted gap-balancing (60 knees) and conventional measured resection (56 knees). The...

  • 4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty. Rasch, Helmut; Falkowski, Anna; Forrer, Flavio; Henckel, Johann; Hirschmann, Michael // Skeletal Radiology;Sep2013, Vol. 42 Issue 9, p1215 

    Objective: The purpose was to evaluate the intra- and inter-observer reliability of combined quantitative 3D-volumetric single-photon emission computed tomography (SPECT)/CT analysis including size, intensity and localisation of tracer uptake regions and total knee arthroplasty (TKA) position....

  • A prospective comparative study of the midvastus and medial parapatellar approaches for total knee arthroplasty in the early postoperative period. Maru, Michael; Akra, Gabriel; McMurtry, Ian; Port, Andy // European Journal of Orthopaedic Surgery & Traumatology;Oct2009, Vol. 19 Issue 7, p473 

    The commonest surgical approach for total knee arthroplasty is medial parapatellar approach. This involves splitting the quadriceps tendon and disrupts the extensor mechanism and this may potentially weaken it. The midvastus approach involves splitting the vastus medialis muscle instead of...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics