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Updated: May 15, 2026

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

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Computer navigation of soft tissues in total knee replacement.

Yogeesh D Kamat¹, Kamran M Aurakzai, Ajeya R Adhikari

¹Department of Orthopaedics, Elective Orthopaedic Centre, Epsom, United Kingdom. yogeesh.kamat@gmail.com

The Journal of Knee Surgery

|January 5, 2013

Summary

Computer navigation aids total knee replacement (TKR) soft tissue assessment. Ligament balancing (LB) showed better results for knees with preoperative imbalance, suggesting tailored techniques improve TKR outcomes.

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Knee Joint

Knee Joint

The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris group...

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Area of Science:

Orthopedic Surgery
Biomedical Engineering
Surgical Navigation

Background:

Computer navigation has improved total knee replacement (TKR) alignment accuracy.
Current focus is on utilizing navigation for soft tissue assessment in TKR.
Effective soft tissue balancing is crucial for optimal TKR outcomes.

Purpose of the Study:

To compare two distinct soft tissue balancing techniques in TKR: bone referencing (BR) and ligament balancing (LB).
To evaluate the efficacy of computer navigation in assessing tissue balance during TKR.
To determine if preoperative knee status influences the success of different balancing methods.

Main Methods:

A prospectively randomized clinical study involving 77 subjects undergoing TKR.

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Comparison of BR (independent bone cuts, subjective assessment) and LB (tibia-first cut, guided femoral cuts).

Tissue balance assessed via coronal laxity testing and computer navigation-derived range of motion graphs, validated against laxity testing.

Main Results:

No significant difference in overall tissue balance achieved between BR and LB techniques.
Ligament balancing (LB) demonstrated superior results in a subgroup of knees with greater preoperative tissue imbalance.
Computer navigation-generated graphs effectively validated coronal laxity testing for assessing knee range of motion.

Conclusions:

Both bone referencing and ligament balancing can achieve comparable tissue balance in TKR.
Ligament balancing may offer advantages for patients with significant preoperative knee instability.
Tailoring the tissue balancing technique based on preoperative assessment is recommended for optimizing TKR results.