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Alignment deviation between bone resection and final implant positioning in computer-navigated total knee

Fabio Catani¹, Nicola Biasca, Andrea Ensini

¹Movement Analysis Laboratory, Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy.

The Journal of Bone and Joint Surgery. American Volume

|April 3, 2008

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Computer-navigated total knee arthroplasty can still have alignment errors during component implantation. Careful checks are needed before cement hardening to ensure accurate prosthetic component positioning.

Area of Science:

Orthopedic Surgery
Biomedical Engineering
Medical Device Technology

Background:

Computer navigation in total knee arthroplasty (TKA) aims to enhance prosthetic component positioning and lower limb alignment.
While navigation systems optimize bone resections, manual implantation steps can introduce significant alignment deviations.
This study quantifies alignment errors from manual component impaction post-navigation-assisted bone resection.

Purpose of the Study:

To measure alignment deviations during tibial and femoral component implantation in computer-navigated TKA.
To assess the impact of manual surgical actions on final component alignment after navigation-guided bone preparation.

Main Methods:

Ninety-one primary TKAs utilized an image-free knee navigation system.

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Alignment of bone resections was measured in three planes using the navigation system's probe.

Alignment was re-measured after cemented component implantation to determine positioning errors.

Main Results:

Alignment deviations exceeding 1 degree occurred in 20% (femur frontal), 11% (tibia frontal), and 33% (tibia sagittal) of patients.
Deviations exceeding 2 degrees were observed in 4% (femur frontal), 3% (tibia frontal), and 9% (tibia sagittal) of patients.
Significant deviations up to 3 degrees were noted in the tibial sagittal plane (posterior slope).

Conclusions:

Manual implantation, including cementation and impaction, introduces considerable alignment error in TKA, irrespective of initial bone resection accuracy.
Post-navigation, careful verification of prosthetic component alignment before cement hardening is crucial.
This highlights the need for intraoperative checks to mitigate alignment inaccuracies in navigated TKA.