DOES COMPUTER ASSISTED TOTAL KNEE ARTHROPLASTY IMPROVE THE OVERALL COMPONENT POSITION?

Abstract

There remains controversy as to whether computer-navigated TKA improves the overall alignment of the knee prosthesis. The aim of this study was to determine whether computer-assisted total knee arthroplasty provides superior prosthesis positioning when compared to a conventional jig-assisted total knee replacement.

A prospective controlled study comparing computer navigated and conventional jig-assisted total knee replacement in 23 patients who underwent bilateral TKA was undertaken to determine if there was any significant difference in component position. The 23 patients (46 knees) were randomised to receive one conventional jig-assisted total knee replacement, and a contra lateral computer-assisted total knee replacement. A single experienced knee surgeon performed all procedures.

A quantitative assessment of the spatial positioning of the implant in the 46 total knee replacements was determined using a low-dose dual-beam CT scanning technique. This resulted in six parameters of alignment that were compared. A blinded, independent observer recorded all radiological measurements.

Median external rotation of the femoral component relative to the trans-epicondylar axis was −2 degrees in the computer-assisted group and −3 degrees in the jig-assisted group. Median femoral component flexion was identical in both groups at 0 degrees. Median valgus angulation of the femoral and tibial components was +1 degree and 0 degree respectively for the computer-assisted group and 0 degree and −1 degree for the jig-assisted group. Median posterior tibial prosthesis slope was +5 degree in both the computer-assisted group and the jig-assisted group.

Computer-assisted implantation of total knee replacements does not offer a significant advantage in prosthesis alignment. Low dose dual-beam CT scanning provides a three dimensional model of the lower limb, allowing accurate measurement of prosthesis alignment.