Abstract
Introduction
It is widely accepted that computer navigation more reliably restores neutral mechanical alignment than conventional instrumentation in total knee arthroplasty (TKA) surgery. Recently, magnetic resonance (MR) based instrumentation has been introduced to the market with a rapid growth in usage. However, a paucity of comparative data still exists on the precision of magnetic resonance (MR) based instruments in achieving acceptable lower limb alignment when compared to other validated techniques. In this analysis, we compare the radiographic outcomes of 3 techniques to achieve satisfactory prosthetic alignment by 2 surgeons using the same prosthesis and surgical technique.
Methods
A series of 180 patients who had undergone TKA surgery were included in this study. Two fellowship-trained knee surgeons performed all surgeries using the same cemented, posterior stabilized implants (NexGen, Zimmer, Warsaw, In). Patients were stratified in to 3 groups according to the technique used to align the knee; 1. Conventional Intra-medullary Instrumentation, 2. Computer Navigation (Orthosoft), and 3. MR-based guides (Zimmer PSI). All patients underwent a post-operative CT Perth Protocol to assess coronal, sagittal and rotational alignment of the femoral and tibial implants. A radiographer who was blinded to the alignment technique used performed all radiographic measurements. Outliers were defined at a deviation of more than 3 degrees from the mechanical axis in all planes of motion.
Results
The radiographic outcome measures will be presented to highlight the significant differences between 3 groups. In addition, the early surgical experience with the introduction of MR based instruments will be reviewed along with the early problems encountered from tibial sagittal alignment that became apparent with time.
Conclusion
The rapid introduction of MR based instruments in to the market by several prosthetic companies has occurred without adequate pre-release analysis. This study will allow surgeons to make an informed decision on whether to use this technology based on validated radiographic measures, when compared to both conventional alignment techniques and computer navigation.
