INTRODUCTION Computer-assisted navigation was recently introduced to help for accurate component positioning. However, considering the evidence available in the literature, the superiority of CAS, compared to the "freehand" approach, is still far from proven. The purpose of the study is to identify the strengths and limitations of the computer-assisted TKA (GPS), comparing navigated procedures with conventional ones. We hypothesize that the GPS navigation technique is not inferior to conventional technique at least two years of follow-up in clinical, radiological, and perioperative outcomes. MATERIAL AND METHODS This is a Multicentric Controlled Retrospective Clinical Study. The clinical databases and medical records of involved centers were retrospectively analyzed, and then according to study time-lapse, inclusion, and exclusion criteria, a consecutive enrollment was performed. The study population is composed of patients who underwent TKA with the same type of implant for both technique and the same compatible navigation system. Were excluded from the study patients affected by secondary knee OA, homolateral hip and ankle OA, tumors, rheumatological pathology, psychiatric illness, and history of alcohol abuse or drug abuse. RESULTS According to inclusion and exclusion criteria and study time-lapse were identified and enrolled 42 patients that underwent to Navigated TKA (NAVI group) and 61 patients that underwent to Conventional TKA (CONV group). Mean follow-up was 3.05 years for the NAVI group and 2.99 years for CONV. Analyzing surgical reports, a statistically significant (P <0.001) higher surgical time was registered for the NAVI group. Although NAVI had a lower intraoperative blood loss than the control group, no statistically significant difference was found. As expected, the intragroup analysis showed a statistically significant increase comparing preoperative with minimum two years follow-up value for all three scores administered (P <0.001). The postoperative intergroup analysis reported no statistically significant difference between NAVI and CONV groups. The average preoperative mechanical alignment was 4.28° varus for the NAVI group and 4.15° of varus for the CONV group. Postoperative lower limb alignment shows a 0.44° varus in the NAVI group and 0.41° varus in the CONV group. Five patients in the NAVI group and 6 in the CONV group presented higher than 3° of mechanical malalignment and were considered outliers. The femoral component’s coronal alignment resulted in 4.1° valgus in the NAVI group and 3.9° valgus in the CONV group. Statistical analysis showed no significant difference between groups in any variable. Post-procedure data analysis was performed on 20 patients who underwent Navigated TKA. There were no statistically significant differences between TARGET and DIGITIZED values except for varus/valgus tibial cut variables that presented the series’ highest mean difference. The value of the differences between values is always within the clinically acceptable range [-1, 1]. DISCUSSION Although knee arthroplasty provides a durable long-term result, malalignment may lead to decreased prosthetic components' survival. The implant's positive outcome and long-term survival are strictly associated with component orientation, soft tissue balance, and the correct restoration of the leg axis. The NAVI group reported a statistically significant higher surgical time among perioperative parameters in the current analysis. A lower intraoperative blood loss was found in the computer-assisted group. Implant survival analysis did not show differences between groups during the follow-up period. Both groups reached statistically significant higher clinical scores compared to baseline. Intergroup analysis showed that implants performed with computer assistance had no postoperative difference with the conventional group using the same implant. According to the radiologic analysis, the computer-assisted group showed no inferiority compared with the conventional group. After surgery, the lower limb obtained a neutral alignment and the implant a correct component position both in the tibial both in the femoral side in both groups. Moreover, no difference in patients with lower limb mechanical malalignment grater that 3°, considered outliers, was found. Navigation system accuracy reported differences in a clinically acceptable range [-1, 1]. CONCLUSION The present study showed that computer-assisted arthroplasty is not inferior to conventional ones. GPS resulted accurate and able to receive an intraoperative adjustment.

Multicentric Controlled Retrospective Clinical Study About Outcomes Of Computer-Assisted Total Knee Arthroplasty Compared To Conventional TKA / Biagio Zampogna - : . , 2021 Jun 21. ((33. ciclo

Multicentric Controlled Retrospective Clinical Study About Outcomes Of Computer-Assisted Total Knee Arthroplasty Compared To Conventional TKA

2021-06-21

Abstract

INTRODUCTION Computer-assisted navigation was recently introduced to help for accurate component positioning. However, considering the evidence available in the literature, the superiority of CAS, compared to the "freehand" approach, is still far from proven. The purpose of the study is to identify the strengths and limitations of the computer-assisted TKA (GPS), comparing navigated procedures with conventional ones. We hypothesize that the GPS navigation technique is not inferior to conventional technique at least two years of follow-up in clinical, radiological, and perioperative outcomes. MATERIAL AND METHODS This is a Multicentric Controlled Retrospective Clinical Study. The clinical databases and medical records of involved centers were retrospectively analyzed, and then according to study time-lapse, inclusion, and exclusion criteria, a consecutive enrollment was performed. The study population is composed of patients who underwent TKA with the same type of implant for both technique and the same compatible navigation system. Were excluded from the study patients affected by secondary knee OA, homolateral hip and ankle OA, tumors, rheumatological pathology, psychiatric illness, and history of alcohol abuse or drug abuse. RESULTS According to inclusion and exclusion criteria and study time-lapse were identified and enrolled 42 patients that underwent to Navigated TKA (NAVI group) and 61 patients that underwent to Conventional TKA (CONV group). Mean follow-up was 3.05 years for the NAVI group and 2.99 years for CONV. Analyzing surgical reports, a statistically significant (P <0.001) higher surgical time was registered for the NAVI group. Although NAVI had a lower intraoperative blood loss than the control group, no statistically significant difference was found. As expected, the intragroup analysis showed a statistically significant increase comparing preoperative with minimum two years follow-up value for all three scores administered (P <0.001). The postoperative intergroup analysis reported no statistically significant difference between NAVI and CONV groups. The average preoperative mechanical alignment was 4.28° varus for the NAVI group and 4.15° of varus for the CONV group. Postoperative lower limb alignment shows a 0.44° varus in the NAVI group and 0.41° varus in the CONV group. Five patients in the NAVI group and 6 in the CONV group presented higher than 3° of mechanical malalignment and were considered outliers. The femoral component’s coronal alignment resulted in 4.1° valgus in the NAVI group and 3.9° valgus in the CONV group. Statistical analysis showed no significant difference between groups in any variable. Post-procedure data analysis was performed on 20 patients who underwent Navigated TKA. There were no statistically significant differences between TARGET and DIGITIZED values except for varus/valgus tibial cut variables that presented the series’ highest mean difference. The value of the differences between values is always within the clinically acceptable range [-1, 1]. DISCUSSION Although knee arthroplasty provides a durable long-term result, malalignment may lead to decreased prosthetic components' survival. The implant's positive outcome and long-term survival are strictly associated with component orientation, soft tissue balance, and the correct restoration of the leg axis. The NAVI group reported a statistically significant higher surgical time among perioperative parameters in the current analysis. A lower intraoperative blood loss was found in the computer-assisted group. Implant survival analysis did not show differences between groups during the follow-up period. Both groups reached statistically significant higher clinical scores compared to baseline. Intergroup analysis showed that implants performed with computer assistance had no postoperative difference with the conventional group using the same implant. According to the radiologic analysis, the computer-assisted group showed no inferiority compared with the conventional group. After surgery, the lower limb obtained a neutral alignment and the implant a correct component position both in the tibial both in the femoral side in both groups. Moreover, no difference in patients with lower limb mechanical malalignment grater that 3°, considered outliers, was found. Navigation system accuracy reported differences in a clinically acceptable range [-1, 1]. CONCLUSION The present study showed that computer-assisted arthroplasty is not inferior to conventional ones. GPS resulted accurate and able to receive an intraoperative adjustment.
Total Knee Arthroplasty; TKA, Knee; Computer Assisted Surgery; Navigation system
Multicentric Controlled Retrospective Clinical Study About Outcomes Of Computer-Assisted Total Knee Arthroplasty Compared To Conventional TKA / Biagio Zampogna - : . , 2021 Jun 21. ((33. ciclo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/68705
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