Download PDF
J Knee Surg 2021; 34(10): 1080-1084
DOI: 10.1055/s-0040-1701441
Original Article

Navigation Improves the Survival Rate of Mobile-Bearing Total Knee Arthroplasty by Severe Preoperative Coronal Deformity: A Propensity Matched Case–Control Comparative Study

Jean-Yves Jenny
1   Department of Orthopaedics and Trauma, Strasbourg University Hospital, Strasbourg, France
,
Dominique Saragaglia
2   Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, Echirolles, France
,
Michel Bercovy
3   Department of Orthopaedics, Clinique Arago, Paris, France
,
Alain Cazenave
4   Department of Orthopedic Surgery, Institut CALOT, Berck-sur-Mer, France
,
Thierry Gaillard
5   Department of Orthopaedics, Polyclinique du Beaujolais, Arnas, France
,
Frédéric Châtain
6   Department of Orthopaedics, Pole Santé Axone, Saint-Martin-d'Hères, France
,
Brigitte Jolles-Haeberli
7   Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
8   Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
,
Jean-Louis Rouvillain
9   Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, Fort-de-France, France
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The primary hypothesis of this study was that the survival rate over 10 years of total knee arthroplasties (TKAs) implanted with a navigation system was superior to that of TKAs implanted with a conventional technique. The secondary hypothesis was that the severity of the initial coronal deformity had a negative influence on the survival rate. A national, multicentric, retrospective study was performed in France, including eight university or private centers with high volumes in knee surgery. Cases operated on with either a conventional (control group) or a navigated (study group) technique were matched after calculating the propensity score using the logistic regression technique. All patients were contacted after 10 years or more to determine the survival of the TKA. The need for date and cause of revision were noted. The primary end point of the study was the occurrence of a revision for any mechanical reason. Survival curves were calculated using the Kaplan–Meier's technique, with the primary criterion as end point. The influence of the implantation technique was analyzed by a log-rank test at a 5% level of significance. The influence of severity of the preoperative coronal deformity was analyzed using the same technique. A total of 513 cases were included in each group. The survival rates after 13 years were 96.5% in the study group and 92.9% in the control group (not significant). There was no significant difference between both groups for the survival rates after 13 years for small deformity (96.0 vs. 97.0%), but the difference was significant for large deformity (97.0 vs. 89.0%, p = 0.04). The results suggest that the use of a navigation system, allowing a more consistent correction of the preoperative coronal deformity, thus allows a better long-term prosthetic survival in cases with a large initial coronal deformity. A navigation system should be routinely used in cases of initial coronal deformity greater than or equal to 10 degrees, as conventional techniques do not routinely provide satisfactory axial correction in these difficult cases.

Keywords

total knee arthroplasty - conventional technique - navigation - deformity - survival


Publication History

Received: 25 June 2019

Accepted: 13 December 2019

Article published online:
19 February 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Vandekerckhove PJ, Lanting B, Bellemans J, Victor J, MacDonald S. The current role of coronal plane alignment in total knee arthroplasty in a preoperative varus aligned population: an evidence based review. Acta Orthop Belg 2016; 82 (01) 129-142
    Google Scholar
  • 2 Park JK, Seon JK, Cho KJ, Lee NH, Song EK. Is immediate postoperative mechanical axis associated with the revision rate of primary total knee arthroplasty? A 10-year follow-up study. Clin Orthop Surg 2018; 10 (02) 167-173
    CrossrefPubMedGoogle Scholar
  • 3 Takahashi T, Ansari J, Pandit HG. Kinematically aligned total knee arthroplasty or mechanically aligned total knee arthroplasty. J Knee Surg 2018; 31 (10) 999-1006
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Liu HX, Shang P, Ying XZ, Zhang Y. Shorter survival rate in varus-aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2663-2671
    CrossrefPubMedGoogle Scholar
  • 5 Oh SM, Bin SI, Kim JY, Cho HI, Lee BS, Kim JM. Does the preoperative varus deformity influence the survival of postoperative neutral-aligned TKAs? An analysis with a minimum 5-year follow-up. J Arthroplasty 2018; 33 (10) 3181-3185
    CrossrefPubMedGoogle Scholar
  • 6 Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK. Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 2005; 20 (07) 832-839
    CrossrefPubMedGoogle Scholar
  • 7 Baier C, Wolfsteiner J, Otto F. et al. Clinical, radiological and survivorship results after ten years comparing navigated and conventional total knee arthroplasty: a matched-pair analysis. Int Orthop 2017; 41 (10) 2037-2044
    CrossrefPubMedGoogle Scholar
  • 8 Song EK, Agrawal PR, Kim SK, Seo HY, Seon JK. A randomized controlled clinical and radiological trial about outcomes of navigation-assisted TKA compared to conventional TKA: long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3381-3386
    CrossrefPubMedGoogle Scholar
  • 9 Todesca A, Garro L, Penna M, Bejui-Hugues J. Conventional versus computer-navigated TKA: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1778-1783
    CrossrefPubMedGoogle Scholar
  • 10 Siu D, Cooke TD, Broekhoven LD. et al. A standardized technique for lower limb radiography. Practice, applications, and error analysis. Invest Radiol 1991; 26 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 11 Arbab D, Reimann P, Brucker M, Bouillon B, Lüring C. Alignment in total knee arthroplasty - a comparison of patient-specific implants with the conventional technique. Knee 2018; 25 (05) 882-887
    CrossrefPubMedGoogle Scholar
  • 12 Marchand RC, Sodhi N, Khlopas A. et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Saragaglia D, Sigwalt L, Gaillot J, Morin V, Rubens-Duval B, Pailhé R. Results with eight and a half years average follow-up on two hundred and eight e-Motion FP® knee prostheses, fitted using computer navigation for knee osteoarthritis in patients with over ten degrees genu varum. Int Orthop 2018; 42 (04) 799-804
    CrossrefPubMedGoogle Scholar
  • 14 Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R. The influence of preoperative deformity on intraoperative soft tissue balance in posterior-stabilized total knee arthroplasty. J Arthroplasty 2011; 26 (08) 1291-1298
    CrossrefPubMedGoogle Scholar
  • 15 Matziolis G, Matziolis D, Perka C. Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. Int Orthop 2012; 36 (01) 79-82
    CrossrefPubMedGoogle Scholar
  • 16 Cho KJ, Seon JK, Jang WY, Park CG, Song EK. Objective quantification of ligament balancing using VERASENSE in measured resection and modified gap balance total knee arthroplasty. BMC Musculoskelet Disord 2018; 19 (01) 266
    CrossrefPubMedGoogle Scholar
  • 17 Meneghini RM, Ziemba-Davis MM, Lovro LR, Ireland PH, Damer BM. Can intraoperative sensors determine the “target” ligament balance? Early outcomes in total knee arthroplasty. J Arthroplasty 2016; 31 (10) 2181-2187
    CrossrefPubMedGoogle Scholar
  • 18 Kornilov N, Kulyaba T, Petukhov A, Ignatenko V, Thienpont E. Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach. Acta Orthop Belg 2015; 81 (04) 673-681
    PubMedGoogle Scholar
  • 19 Saragaglia D, Chaussard C, Rubens-Duval B. Navigation as a predictor of soft tissue release during 90 cases of computer-assisted total knee arthroplasty. Orthopedics 2006; 29 (10, Suppl): S137-S138
    PubMedGoogle Scholar
  • 20 Hakki S, Coleman S, Saleh K, Bilotta VJ, Hakki A. Navigational predictors in determining the necessity for collateral ligament release in total knee replacement. J Bone Joint Surg Br 2009; 91 (09) 1178-1182
    CrossrefPubMedGoogle Scholar
  • 21 Lee DH, Shin YS, Jeon JH, Suh DW, Han SB. Flexion and extension gaps created by the navigation-assisted gap technique show small acceptable mismatches and close mutual correlations. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1793-1798
    CrossrefPubMedGoogle Scholar
  • 22 Kamat YD, Aurakzai KM, Adhikari AR. Computer navigation of soft tissues in total knee replacement. J Knee Surg 2013; 26 (03) 145-150
    PubMedGoogle Scholar
  • 23 Luring C, Hüfner T, Perlick L, Bäthis H, Krettek C, Grifka J. The effectiveness of sequential medial soft tissue release on coronal alignment in total knee arthroplasty: using a computer navigation model. J Arthroplasty 2006; 21 (03) 428-434
    CrossrefPubMedGoogle Scholar
  • 24 Cip J, Obwegeser F, Benesch T, Bach C, Ruckenstuhl P, Martin A. Twelve-year follow-up of navigated computer-assisted versus conventional total knee arthroplasty: a prospective randomized comparative trial. J Arthroplasty 2018; 33 (05) 1404-1411
    CrossrefPubMedGoogle Scholar
  • 25 Kim YH, Park JW, Kim JS. 2017 Chitranjan S. Ranawat Award: does computer navigation in knee arthroplasty improve functional outcomes in young patients? A randomized study. Clin Orthop Relat Res 2018; 476 (01) 6-15
    CrossrefPubMedGoogle Scholar
  • 26 de Steiger RN, Liu YL, Graves SE. Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 2015; 97 (08) 635-642
    CrossrefPubMedGoogle Scholar
  • 27 Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF. Does axial limb rotation affect the alignment measurements in deformed limbs?. Clin Orthop Relat Res 2000; (371) 246-252
    CrossrefPubMedGoogle Scholar
  • 28 Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 2004; 86 (06) 818-823
    CrossrefPubMedGoogle Scholar
  • 29 Sailhan F, Jacob L, Hamadouche M. Differences in limb alignment and femoral mechanical-anatomical angles using two dimension versus three dimension radiographic imaging. Int Orthop 2017; 41 (10) 2009-2016
    CrossrefPubMedGoogle Scholar
  • 30 Jupiter DC. Propensity score matching: retrospective randomization?. J Foot Ankle Surg 2017; 56 (02) 417-420
    CrossrefPubMedGoogle Scholar
  • 31 Heesterbeek PJC, van Houten AH, Klenk JS. et al. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (05) 1524-1531
    CrossrefPubMedGoogle Scholar
  • 32 Huang TL, Wang CC, Yang KC, Wu CC. Reliability of roentgenographic knee alignment measurements in gonarthrosis. J Knee Surg 2018; 31 (04) 302-305
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Batash R, Rubin G, Lerner A, Shehade H, Rozen N, Rothem DE. Computed navigated total knee arthroplasty compared to computed tomography scans. Knee 2017; 24 (03) 622-626
    CrossrefPubMedGoogle Scholar
  • 34 Meijer MF, Boerboom AL, Bulstra SK, Reininga IHF, Stevens M. Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA?. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2894-2903
    CrossrefPubMedGoogle Scholar