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General Orthopaedics

KNEE NAVIGATION: LOST IN SPACE – OPPOSES

The Current Concepts in Joint Replacement (CCJR) Winter Meeting, 14 – 17 December 2016.



Abstract

There is enough evidence to show that navigation improves precision of component placement and consistent and accurate restoration of limb alignment, allowing the surgeon to achieve the desired neutral or kinematic alignment. Computer-assisted TKA provides excellent information regarding gap equality and symmetry throughout the knee range of motion. Accurate soft-tissue balancing is facilitated by CAS. It allows precise, quantitative soft tissue release for deformities, especially in knees with severe flexion contractures and severe rigid varus and valgus deformities. It allows accurate restoration of joint line, and posterior femoral offset. Knee arthritis with complex extra-articular deformities and in-situ hardware can be tackled appropriately using computer navigation where conventional techniques may be inadequate. It also allows intra-articular correction for extra-articular deformities due to malunions and facilitates extra-articular correction in cases with severe extra-articular tibial deformities. In obese patients, where the alignment of the limb is difficult to assess, computer navigation improves accuracy and reduces the number of outliers. The ability to quantify the precise amount of bone cuts and soft tissue releases needed to equalise gaps and restore alignment, reduced blood loss, and reduced incidence of systemic emboli improves the safety of the procedure and hastens functional recovery of the patient. Recent evidence shows that the rate of revision especially in younger patients is reduced with navigation.