Abstract
Introduction
Computer assisted surgery (CAS) systems have been shown to improve alignment accuracy in total knee arthroplasty (TKA), yet concerns regarding increased costs, operative times, pin sites, and the learning curve associated with CAS techniques have limited its widespread acceptance. The purpose of this study was to compare the alignment accuracy of an accelerometer-based, portable navigation device (KneeAlignÒ 2) to a large console, imageless CAS system (AchieveCAS). Our hypothesis is that no significant difference in alignment accuracy will be appreciated between the portable, accelerometer-based system, and the large-console, imageless navigation system.
Methods
62 consecutive patients, and a total of 80 knees, received a posterior cruciate substituting TKA using the Achieve CAS computer navigation system. Subsequently, 65 consecutive patients, and a total of 80 knees, received a posterior cruciate substituting TKA using the KneeAlignÒ 2 to perform both the distal femoral and proximal tibial resections (femoral guide seen in Figure 1, and tibial guide seen in Figure 2). Postoperatively, standing AP hip-to-ankle radiographs were obtained for each patient, from which the lower extremity mechanical axis, tibial component varus/valgus mechanical alignment, and femoral component varus/valgus mechanical alignment were digitally measured. Each measurement was performed by two, blinded independent observers, and interclass correlation for each measurement was calculated. All procedures were performed using a thigh pneumatic tourniquet, and the total tourniquet time for each procedure was recorded.
Results
In the KneeAlignÒ 2 cohort, 92.5% of patients had an alignment within 3° of a neutral mechanical axis (vs. 86.3% with AchieveCAS, p<0.01), 96.2% had a tibial component alignment within 2° of perpendicular to the tibial mechanical axis (vs. 97.5% with AchieveCAS, p=0.8), and 94.9% had a femoral component alignment within 2° of perpendicular to the femoral mechanical axis (vs. 92.5% with AchieveCAS, p<0.01). The mean tourniquet time in the KneeAlignÒ 2 cohort was 48.1 + 10.2 minutes, versus 54.1 + 10.5 in the AchieveCAS cohort (p<0.01).
The interclass correlation coefficient for measurement of the postoperative tibial alignment was 0.92, for femoral alignment was 0.85, and for overall lower extremity alignment was 0.94.
Conclusion
Accelerometer-based, portable navigation can provide the same degree of alignment accuracy as large console, imageless CAS system in TKA, while also decreasing operative times. The KneeAlignÒ 2 successfully combines the benefits and accuracy of large-console, CAS systems, while avoiding the use of extra pin sites, decreasing operative times, and providing a level of familiarity with conventional alignment methods.
