Bilgisayarla navigasyonun total diz artroplastisinde komponent dizilimine etkisi

Abstract

Amaç: Bu retrospektif, kesitsel çalışmada bilgisayar yardımlı total diz artroplastisinin (TDA) komponent dizilimine etkisinin incelenmesi amaçlandı. Çalışma planı: İki yıllık süreç içinde bilgisayar yardımlı TDA uygulanan 20 hastanın radyografileri mekanik femorotibial, mekanik femoral, mekanik tibial açılar (sırasıyla, mFTA, mFA ve mTA) ve tibial eğim (s) açısından incelendi. Bulgular: Ameliyat sonrası ortalama mFTA (179.7°) ameliyat öncesi değerle karşılaştırıldığında (175.45°) anlamlı derecede düşüş gösterdi (p=0.012). Ameliyat sonrası ortalama mFA da (89.1°) ameliyat öncesi değere (90.6°) göre anlamlı derecede azalmıştı (p=0.035). Ameliyat sonrası ortalama mTA tam olarak 90.0° kaydedilirken, ameliyat öncesi değeri (87.7°) anlamlı derecede daha düşüktü (p=0.003). TDA sırasında ortalama turnike süresi 109.5 dakika olarak ölçüldü. Çıkarımlar: Bilgisayarla navigasyon TDA’da implant konumlandırması ve komponent diziliminin iyileştirilmesi için güvenilir bir sistemdir.

Keywords

• Bilgisayarla navigasyon; gonartroz; implant konumlandırma; ligaman dengeleme; total diz protezi.

The effect of computerized navigation on component alignment in total knee arthroplasty

Abstract

Objective: The aim of this retrospective cross-sectional study was to evaluate the effect of computerassisted total knee arthroplasty (TKA) on component alignment.
Methods: The radiographs of 20 patients who underwent computer-assisted TKA within a two-year period were analyzed with respect to the mechanical femorotibial, mechanical femoral, mechanical tibial angles (mFTA, mFA and mTA, respectively) and the tibial slope (σ).
Results: The mean postoperative mFTA (179.7°) was significantly improved when compared to the preoperative value (175.45°) (p=0.012). The mean postoperative mFA was significantly reduced
(p=0.035) in comparison with the preoperative mean (89.1° and 90.6°, respectively). The mean postoperative mTA was exactly 90.0°, while the preoperative mean was significantly lower (87.7°; p=0.003). Mean tourniquet time during TKA was 109.5 minutes.
Conclusion: Computer navigation in TKA appears to be a reliable system which facilitates implant positioning and component alignment. 

Keywords

• Computer navigation
• gonarthrosis
• implant positioning
• ligament balancing
• total knee replacement

References

1. Stindel E, Gil D, Briard JL, Merloz P, Dubrana F, Lefevre C. Evaluation de la précision et de la reproductibilité de l’algorithme « surgetic » de détection du centre hanche. In: Troccaz J, Merloz P, editors. Surgetica 2002. Gestes médico-chirurgicaux assistés par ordinateur: outils et applications [Computer-aided medical interventions: tools and applications]. Paris: Sauramps Médical; 2002. p. 48.
2. Aglietti P, Buzzi R. Posterior stabilized total-condylar knee replacement. Three to eight years’ follow-up of 85 knees. J Bone Joint Surg Br 1988;70:211.
3. Hansen AD, Rand JA. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am 1998;80:910-22.
4. Taylor RH, Lavallée S, Burdea GC, Mösges R. Computerintegrated surgery. Technology and clinical applications. 19 Clin Orthop Relat Res 1998;(354):5-7.
5. Saragaglia D, Picard F, Chaussard C, Montbarbon E, Leitner F, Cinquin P. Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study. [Article in French] Rev Chir Orthop Reparatrice Appar Mot 2001;87:18-28.
6. Townley CD. The anatomic total knee: instrumentation and alignment technique. In: Dorr LD, editor. The Knee: Papers of the First Scientific Meeting of the Knee Society. Baltimore: University Press; 1985. p. 39-54.
7. Nodé-Langlois L. Pre- and postoperative dimensional analysis of the angular deviations of the axes of the lower limb. [Doctorate thesis in French]. Paris: L’École Nationale Supérieure d’Arts et Métiers; 2003.
8. Jenny JY, Boeri C. Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation. [Article in French] Rev Chir Orthop Reparatrice Appar Mot 2001;87:645-52.

9. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Br 2003;85:830-5.
10. Nizard RS, Groupe Guépar. System of computer-assisted surgery for total knee replacement. Theoretical justification. Current status. [Article in French] Paris: Cahier d’Enseignement de La Societé Française de Chirurgie Orthopédique et Traumatologique; 2002. p. 175.
11. Selmi T A, Zanone X, Neyret P. Knee prosthesis in malunion. [Article in French] Chirurgie prothétique du genou. Paris: Sauramps Médical; 1999. p. 221-39.
12. Badet R, Ait Si Selmi TA, Neyret P. Tibial valgus osteotomy after total knee arthroplasty. In: Chambat P, Neyret P, Deschamps G, editors. [Article in French] La chirurgie prothétique du genou. Paris: Sauramps Médical; 1999. p. 241
13. Hasegawa M, Yoshida K, Wakabayashi H, Sudo A. Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome. Knee Surg Sports Traumatol Arthrosc 2011;19:904
14. Fehring TK, Mason JB, Moskal J, Pollock DC, Mann J, Williams VJ. When computed-assisted knee replacement is the best alternative. Clin Orthop Relat Res 2006;452:132-6. Biasca N, Wirth S, Bungartz M. Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee 2009;16:22-9.
15. Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res 1998;(354):49-56.
16. Tayot O, Boufarah C, Chavane H, Béjui-Huges J. Comparison of a series of 70 navigated TKA with a series of 70 classic TKA implants. [Presentation in French] 79th Annual Meeting of the Society of French Orthopaedic Surgery and Traumatology; November, 2004; Paris.
17. Lambilly C, Courjaud X, Merlaud L. Contribution of rotating platform navigated knee surgery in positioning a total of 100 prostheses. [Presentation in French] 79th Annual Meeting of the Society of French Orthopaedic Surgery and Traumatology; November, 2004; Paris.
18. Seon JK, Song EK. Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty 2006;21:777-82.
19. Picard F. Le geste médico-chirurgical assisté par ordinateur (GMCAO). Symposium Ceraver; June, 2003:197; Helsinki.