[Computer-assisted total knee arthroplasty: 12 years experience in Grenoble]

Area of Science:

• Orthopedic surgery
• Medical device technology
• Biomechanical engineering

Context:

• Computer-assisted surgery (CAS) has evolved significantly.
• Total knee arthroplasty (TKA) aims to restore joint function and alleviate pain.
• Traditional TKA relies on conventional instrumentation, which can present challenges in achieving optimal alignment and balance.

Purpose:

• To describe the development and application of a computer-assisted system for total knee arthroplasty.
• To highlight the system's passive nature, reliance on kinematics and palpation, and surgeon control.
• To discuss the benefits of computer assistance in TKA, including improved accuracy in bone preparation and ligament balancing.

Summary:

• Computer-assisted TKA, developed in Grenoble, utilizes a passive system based on kinematics and palpation, requiring no pre- or perioperative imaging.
• The system assists surgeons by identifying the lower leg axis, accurately fixing bone cutting guides, and checking ligament balance, surpassing limitations of conventional tools.
• Since its first human implantation in 1997, over 200,000 patients globally have received this device, with the surgeon maintaining full control.

Impact:

• The effectiveness of computer-assisted TKA is supported by substantial clinical experience.
• While alignment is crucial, long-term studies are necessary to definitively link precise alignment with improved prosthesis survival rates.
• Further research with modern prostheses is essential to validate historical findings and confirm long-term outcomes.