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Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect
Alberto Carli1, Ahmed Aoude1, Avishai Reuven2
1The Division of Orthopaedic Surgery, McGill University, Montréal, Que.
Background:
Few studies have compared the effect of different computer navigation systems on postoperative alignment in patients who have had total knee arthroplasty (TKA). We examined 2 computed tomography (CT)-free computer navigation systems by comparing the accuracy of intraoperative measurements to postoperative alignment.
Methods:
Patients underwent unilateral TKA performed by a single surgeon using 1 of 2 CT-free navigation systems. We compared final intraoperative tibial and femoral coronal angles and mechanical axis with the same angles measured on standing postoperative radiographs.
Results:
Groups of 31 and 50 patients underwent TKA with the 2 systems, respectively. We noted a significant difference in the coronal tibial implant angle (1.29º ± 1.35º) and in the mechanical axis (1.59º ± 2.36º) for one navigation system (both p < 0.001), while only the coronal tibial implant angle showed a significant difference (1.17º ± 1.65º, p < 0.001) for the second system. The number of radiographic outliers also significantly differed. A significantly higher proportion (32%; p < 0.01) of patients in the second cohort exhibited unacceptable malalignment compared with the first cohort (24%).
Conclusion:
Navigation systems for TKA continue to increase in sophistication and popularity. Owing to the significant difference in the proportion of alignment outliers in the 2 navigation systems tested in this study, orthopedic surgeons should not consider all TKA navigation systems equivalent. Additional investigations are needed to compare the accuracy of a variety of CT-free and CT-based navigation systems and to confirm our finding that accuracy is system-dependent.
