Computer-assisted FluoroGuide navigation of unicompartmental knee arthroplasty

Most authorities recognize minimally invasive unicompartmental knee arthroplasty (UKA) as technically demanding with concerns regarding loss of implantation accuracy. We have previously reported on the potential inaccuracy of femoral intramedullary guides in UKA leading to poor component positioning. Our 3-dimensional analysis of alignment error showed that a short, narrow intramedullary rod inserted according to the manufacturer's specifications did not accurately find the direction of the anatomic axis, with errors occurring in both the coronal and sagittal planes. We sought to evaluate whether a fluoroscopic computer-assisted minimally invasive UKA procedure would improve the accuracy and precision in the placement of the femoral component in the coronal and sagittal planes compared with conventional surgery.

We performed a prospective study involving cohorts of 45 conventional versus 53 navigated UKAs. A single surgeon performed all surgeries over a 4-year period.

Pain and knee function significantly improved in both surgical groups at 1 and 2 years after surgery. At a minimum of 1-year follow-up, radiographic evaluation revealed significant improvements in coronal alignment precision of the tibial component (p = 0.026) and sagittal alignment precision of the femoral component for the navigated group (p = 0.037). The use of a fluoroscopic computer-assisted technique did not significantly improve the accuracy of any of the alignment angles.

We cannot justify the additional expense and complexity imposed by fluoroscopic navigation despite the observed improvements in alignment precision. Improved positioning precision may translate into a greater number of long-term functional results, but larger, longer-term studies are needed.