Introduction

Computer Assisted Total Knee Arthroplasty (CATKA) has proven benefits of achieving reproducible and accurate component alignment with outcomes comparable to conventional jig based TKR. Optical trackers are required for assessment of alignment and are fixed via bone pins. This technique does present its own unique complications including fracture and infection at the pin- sites. We report our experience of a single surgeon series performing CATKA.

Introduction

Computer assisted total knee replacement (CATKR) has been shown to give reproducible and accurate alignment of the mechanical axis. The benefits of the reproducible technique has been demonstrated in literature but there is little evidence of benefits in training junior surgeons in a clinical setting. We show our experience of CATKR performed by junior staff under supervision by the senior author, looking at component alignment and patient reported outcome measures.

Introduction

Minimally invasive Computer Assisted Total Knee Arthroplasty (MICATKA) has benefits of reduced blood loss, shorter hospital stay, improved post-operative quadriceps function and enhanced post-operative recovery. Our study looked into these factors to compare if there was a significant difference when compared to conventional Computer Assisted Total Knee Arthroplasty (CATKA).

Introduction

Unicondylar knee replacement (UKR) surgery is proven long term results in its benefit in medial compartment OA. However, its results are sensitive to component alignment with poor alignment leading to early failure. The advent of computer navigation has resulted in improved mechanical alignment, but little has been published on the outcomes of navigated UKR surgery. We present the results of 253 consecutive Computer Assisted UKR's performed by a single surgeon.

Introduction

The advent of double bundle ACL (Anterior Cruciate Ligament) reconstruction had been hailed as potentially allowing for more anatomically and physiologically functioning graft, however until recently there had been little evidence of enhanced functional outcomes.

The aim of this study is to explore whether the dimensions of hamstring two strand single bundle grafts, are predictive of the combined four strand single bundle graft that results from combining the single bundle grafts, as well as the impact of double bundle grafts upon the available healing and attachment area within the bony tunnels.

Minimally invasive total knee arthroplasty is growing in popularity. It appears to reduce blood loss, reduce hospital stay, improve post-operative quadriceps function and shorten post-operative recovery. We show our experience of minimally invasive TKA with a computer navigation system.

The first series compared forty MICA TKA and forty conventional computer assisted total knee arthroplasties (CATKA). Component positioning was assessed radiographically with long leg Maquet views. Knee Society Scores (KSS) were recorded pre-operatively and at 6, 12, 18 months. Length of stay and recovery of straight leg raise was also recorded. A second series of fifty MICATKA patients were assessed post-operatively for component alignment using long leg Maquet views. Twenty-two of these patients had assessment of femoral rotation using CT.

In the first series pre-operative KSS showed no significant difference between the two groups. Post-operatively the mean femoral component alignment was 89.7 degrees for MICATKA and 90.2 for CATKA. The mean tibial component alignment was 89.7 degrees for both. KSS at 6, 12, 18 months were statistically better in the MICATKA (p<000.1). Straight leg raise was achieved by day one in 93% of the MICATKA compared to 30% of the CATKA. Length of stay for MICATKA was a mean of 3.25 days with CATKA a mean of 6 days. In the second series the mean femoral component varus/valgus angle was 89.98 degrees, the mean tibial component varus/valgus angle was 89.91 degrees and the mean femoral component rotation was 0.6 degrees of external rotation.

MICATKA is a safe procedure with reproducible results. Alignment is equivalent to CATKA. It gives statistically significant improvement in KSS compared to the open procedure. The length of stay and time to straight leg raise are also reduced. At 2 years follow-up we have seen no revisions and no evidence of loosening radiographically.