The use of imageless navigation to quantify cutting error in total knee arthroplasty

Abstract Purpose Navigated total knee arthroplasty (TKA) improves implant alignment by providing feedback on resection parameters based on femoral and tibial cutting guide positions. However, saw blade thickness, deflection, and cutting guide motion may lead to final bone cuts differing from planned...

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Autores principales:	Ran Schwarzkopf, Morteza Meftah, Scott E. Marwin, Michelle A. Zabat, Jeffrey M. Muir, Iain R. Lamb
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Knee Osteoarthritis Arthroplasty Computer-assisted navigation Saw blade deflection Navigated TKA Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/7700de6339f24515ae673e9ccc5ca38c
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spelling	oai:doaj.org-article:7700de6339f24515ae673e9ccc5ca38c2021-12-05T12:03:10ZThe use of imageless navigation to quantify cutting error in total knee arthroplasty10.1186/s43019-021-00125-z2234-2451https://doaj.org/article/7700de6339f24515ae673e9ccc5ca38c2021-12-01T00:00:00Zhttps://doi.org/10.1186/s43019-021-00125-zhttps://doaj.org/toc/2234-2451Abstract Purpose Navigated total knee arthroplasty (TKA) improves implant alignment by providing feedback on resection parameters based on femoral and tibial cutting guide positions. However, saw blade thickness, deflection, and cutting guide motion may lead to final bone cuts differing from planned resections, potentially contributing to suboptimal component alignment. We used an imageless navigation device to intraoperatively quantify the magnitude of error between planned and actual resections, hypothesizing final bone cuts will differ from planned alignment. Materials and methods A retrospective study including 60 consecutive patients undergoing primary TKA using a novel imageless navigation device was conducted. Device measurements of resection parameters were obtained via attachment of optical trackers to femoral and tibial cutting guides prior to resection. Following resection, optical trackers were placed directly on the bone cut surface and measurements were recorded. Cutting guide and bone resection measurements of both femoral and tibial varus/valgus, femoral flexion, tibial slope angles, and both femoral and tibial medial and lateral resection depths were compared using a Student's t-test. Results Femoral cutting guide position differed from the actual cut by an average 0.6 ± 0.5° (p = 0.85) in the varus/valgus angle and 1.0 ± 1.0° (p = 0.003) in the flexion/extension angle. The difference between planned and actual cut measurements for medial and lateral femoral resection depth was 1.1 ± 1.1 mm (p = 0.32) and 1.2 ± 1.0 mm (p = 0.067), respectively. Planned cut measurements based on tibial guide position differed from the actual cut by an average of 0.9 ± 0.8° (p = 0.63) in the varus/valgus angle and 1.1 ± 1.0° (p = 0.95) in slope angle. Measurement of medial and lateral tibial resection depth differed by an average of 0.1 ± 1.8 mm (p = 0.78) and 0.2 ± 2.1 mm (p = 0.85), respectively. Conclusions Significant discrepancies between planned and actual femoral bone resection were demonstrated for flexion/extension angle, likely the result of cutting error. Our data highlights the importance of cut verification postresection to confirm planned resections are achieved, and suggests imageless navigation may be a source of feedback that would allow surgeons to intraoperatively adjust resections to achieve optimal implant alignment.Ran SchwarzkopfMorteza MeftahScott E. MarwinMichelle A. ZabatJeffrey M. MuirIain R. LambBMCarticleKneeOsteoarthritisArthroplastyComputer-assisted navigationSaw blade deflectionNavigated TKAOrthopedic surgeryRD701-811ENKnee Surgery & Related Research, Vol 33, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Knee Osteoarthritis Arthroplasty Computer-assisted navigation Saw blade deflection Navigated TKA Orthopedic surgery RD701-811
spellingShingle	Knee Osteoarthritis Arthroplasty Computer-assisted navigation Saw blade deflection Navigated TKA Orthopedic surgery RD701-811 Ran Schwarzkopf Morteza Meftah Scott E. Marwin Michelle A. Zabat Jeffrey M. Muir Iain R. Lamb The use of imageless navigation to quantify cutting error in total knee arthroplasty
description	Abstract Purpose Navigated total knee arthroplasty (TKA) improves implant alignment by providing feedback on resection parameters based on femoral and tibial cutting guide positions. However, saw blade thickness, deflection, and cutting guide motion may lead to final bone cuts differing from planned resections, potentially contributing to suboptimal component alignment. We used an imageless navigation device to intraoperatively quantify the magnitude of error between planned and actual resections, hypothesizing final bone cuts will differ from planned alignment. Materials and methods A retrospective study including 60 consecutive patients undergoing primary TKA using a novel imageless navigation device was conducted. Device measurements of resection parameters were obtained via attachment of optical trackers to femoral and tibial cutting guides prior to resection. Following resection, optical trackers were placed directly on the bone cut surface and measurements were recorded. Cutting guide and bone resection measurements of both femoral and tibial varus/valgus, femoral flexion, tibial slope angles, and both femoral and tibial medial and lateral resection depths were compared using a Student's t-test. Results Femoral cutting guide position differed from the actual cut by an average 0.6 ± 0.5° (p = 0.85) in the varus/valgus angle and 1.0 ± 1.0° (p = 0.003) in the flexion/extension angle. The difference between planned and actual cut measurements for medial and lateral femoral resection depth was 1.1 ± 1.1 mm (p = 0.32) and 1.2 ± 1.0 mm (p = 0.067), respectively. Planned cut measurements based on tibial guide position differed from the actual cut by an average of 0.9 ± 0.8° (p = 0.63) in the varus/valgus angle and 1.1 ± 1.0° (p = 0.95) in slope angle. Measurement of medial and lateral tibial resection depth differed by an average of 0.1 ± 1.8 mm (p = 0.78) and 0.2 ± 2.1 mm (p = 0.85), respectively. Conclusions Significant discrepancies between planned and actual femoral bone resection were demonstrated for flexion/extension angle, likely the result of cutting error. Our data highlights the importance of cut verification postresection to confirm planned resections are achieved, and suggests imageless navigation may be a source of feedback that would allow surgeons to intraoperatively adjust resections to achieve optimal implant alignment.
format	article
author	Ran Schwarzkopf Morteza Meftah Scott E. Marwin Michelle A. Zabat Jeffrey M. Muir Iain R. Lamb
author_facet	Ran Schwarzkopf Morteza Meftah Scott E. Marwin Michelle A. Zabat Jeffrey M. Muir Iain R. Lamb
author_sort	Ran Schwarzkopf
title	The use of imageless navigation to quantify cutting error in total knee arthroplasty
title_short	The use of imageless navigation to quantify cutting error in total knee arthroplasty
title_full	The use of imageless navigation to quantify cutting error in total knee arthroplasty
title_fullStr	The use of imageless navigation to quantify cutting error in total knee arthroplasty
title_full_unstemmed	The use of imageless navigation to quantify cutting error in total knee arthroplasty
title_sort	use of imageless navigation to quantify cutting error in total knee arthroplasty
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7700de6339f24515ae673e9ccc5ca38c
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The use of imageless navigation to quantify cutting error in total knee arthroplasty

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