IS COMPUTER ASSISTED NAVIGATION HELPFUL IN SURGICAL TRAINING?

Abstract

Computer assisted navigation (CAN) has been shown to significantly improve the overall alignment obtained after total knee arthroplasty (TKA). Human error and the use of conventional jigs may be the reasons for the inaccuracy of conventional TKA. The impact of computer assisted equipment in surgeon training has not yet been established.

Three orthopaedic trainees participated in this prospective study to assess the impact of CAN upon intraoperative alignment. Each trainee’s first five (early group) and last five (late group) TKA’s were included in the study during their three month training period. A total of 30 patients were included in the study. The accuracy of conventional jig positioning was assessed simultaneously using navigation equipment. After this assessment, the actual bony resection was performed using CAN equipment.

There was a consistent trend towards improved accuracy between the early and late groups in the majority of parameters assessed. In the early group, the coronal plane tibial alignment was found to be outside the acceptable three degree range in 11 out of 15. In the late group this improved to two out of 15 (p< 0.05). An average of 2.8 degrees of tibial jig deviation during pinning was noted in the early group which improved to one degree in late group. The accuracy of jig placement in both groups was improved by CAN.

Computer assisted navigation is helpful in improving the accuracy of trainee surgeons and should prove a useful adjunct in training. Surgical accuracy using conventional jig based systems can be improved with training. Deviation of conventional tibial alignment jig during pinning is a significant factor. This aspect has not been appreciated fully in the past and can be minimised by the use of the navigation equipment. As shown in previous studies, the overall alignment using CAN is superior to what would have been obtained using conventional jigs for TKA.