Abstract
INTRODUCTION
Soft-tissue balancing of the knee is fundamental to the success of total knee arthroplasty(TKA). Preparing rectangular extension and flexion joint gaps in the most important goal in TKA, because it facilitates functional stability of the knee. In gap balancing technique, we decided the femoral component rotation according to the ligament balance in flexion. Component and limb alignment are important considerations during TKA. Three-dimensional positioning of TKA implants and exact mechanical axis has an effect on implant loosening, polyethylene stresses, and gait. According to the recent reports, the navigation system made it possible to achieve aligned implants more than conventional TKA. Hybrid Navigation technique which is our procedure is combination of navigation system and modified gap technique. In other words, exact mechanical axis is gained by navigation system, stable stability of knee joint is gained by modified gap technique.
PURPOSE
The purpose of this study is to carry out clinical evaluation and image assenssment using computed tomography (CT) of the patients who underwent hybrid navigation technique TKA.
METHODS
We performed TKA using the hybrid navigation technique in 100 knees from April 2012. Surgical technique was that the knees were exposed using a medial parapatellar approach without patella turnover, and the anterior and posterior cruciate ligaments were resected. And next osteotomy distal femur and proximal tibia using CT-free Navigation, step-wise medial soft tissue release was performed to make the rectangular extension joint gap using gap tensor space(off set balancer) at 40 pounds of distraction force. Flextion gap was made at the same distraction force, thereby we determined external rotation angle of femur osteotomy in a patella reduction position. See Figure 1. CT of the whole leg was taken preoperation and postoperation in all cases.
RESULTS
Coronal and sagittal alignments of femoral componet angle were mean 91.05° and mean flex anglewere 2.98°. These alignment of tibial componet angle were 91.08° and mean posterior slope angle were 3.38°. Outliers(>3°)of coronal aligment were 9% in femoral componet, and 8% in tibial componet. Mean operation times(skin incision to skin closure) were 108 minutes. We experienced two complications(1 deep infection and 1 peroneal nerve palsy), but there were no intraoperative fracture, postoperative fracture and DVT/PE.
DISCUSSION AND CONCLUSION
100 patients underwent hybrid navigation TKA which has advantage of both navigation and gap technique. CT assessment of components has shown good results. (outlier>3°femoral component: 9%, tibial component 8%) Short-term postoperative results has shown a good prognosis. We will not understand that we do not observe long-term results in future, neverthless we believe that this technique should be considered as an alternative means of conducting TKA.
