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Pinless navigation in total knee arthroplasty: navigation reduced by the maximum?
Günther Maderbacher1, Jens Schaumburger, Armin Keshmiri
1Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany, Guenther.Maderbacher@klinik.uni-regensburg.de.
International Orthopaedics
|September 23, 2014
Summary
A novel pinless navigation system significantly reduces outliers in total knee arthroplasty (TKA) leg alignment compared to conventional methods. This approach enhances surgical accuracy without increasing risks associated with traditional pins.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Medical Device Technology
Background:
- Achieving neutral mechanical axis alignment (within ±3° of varus/valgus) in total knee arthroplasty (TKA) is crucial for optimal functional outcomes and implant longevity.
- Conventional alignment jigs are associated with significant malalignment in over 20% of TKA cases, leading to suboptimal results.
Purpose of the Study:
- To evaluate the efficacy of a pinless navigation system in reducing outliers beyond the ±3° threshold for leg alignment during TKA.
- To compare the rate of malalignment using a pinless system versus conventional alignment jigs.
Main Methods:
- A randomized prospective study involving 80 patients allocated to either a pinless navigation group or a conventional control group.
- Postoperative assessment of outliers using hip-knee-ankle angle (HKA), mechanical medial proximal tibia angle (mMPTA), and mechanical lateral distal femoral angle (mLDFA).
- Statistical analysis included Student's unpaired t test and Fisher's exact test, with a significance level of p ≤ 0.05.
Main Results:
- The pinless navigation group demonstrated a significant reduction in outliers exceeding ±3° for HKA (p=0.025) and mLDFA (p=0.002).
- Surgery duration was significantly longer in the pinless group (75.6 minutes) compared to the conventional group (64.5 minutes, p<0.001).
Conclusions:
- Pinless navigation is an effective tool for minimizing outliers in TKA's hip-knee-ankle alignment, avoiding pin-related complications like fractures or infections.
- Current pinless systems may lack certain functionalities available in conventional navigation, such as real-time tibiofemoral axis and gap balancing measurements.
