Can mechanical instrumentation compete with a portable navigation system when implanting a total knee prosthesis?
ESSKA Academy. Ferreira A. May 11, 2018; 218088; FP37-1952
Andre Ferreira
Andre Ferreira
Login now to access Regular content available to all registered users.

You can access free non-premium educational content on the ESSKA Academy Portal by registering for free as 'ESSKA Academy User' here
Discussion Forum (0)
Rate & Comment (0)
Objectives: One of the challenge of the new generations of total knee prosthesis (TKA) is to be able to offer a mechanical instrumentation capable of competing with Personal Specific Implants (PSI) and computer assisted surgery navigation (CAS) in terms of precision and reproducibility. Portable surgical navigation, less expensive and less complicated than CAS has shown results equivalent to those of traditional CAS. The aim of this work is to compare the effectiveness of the mechanical instrumentation of a prosthesis of last generation with that of a handheld navigation for the implantation of the same posterior stabilized modern implant.

Methods: After a period of learning curve of 30 cases with each of the two methods, two matched series of 35 patients, operated one with mechanical instrumentation (extra medullary tibial guide, adjustment of the femoral valgus degree by degree, integrated tibial slope to the cutting guide, femoral flexion induced by the ancillary) and the other a handheld navigation system (all the previous adjustable parameters available) were reviewed in a retrospective study. Both populations were strictly comparable in age, BMI, sex, preoperative deformity and bone quality. The femoro-tibial mechanic angle (HKA; aim 0°), the mechanic femoral angle (HKS), the tibial mechanic angle (90°), the tibial slope (3°) and the femoral flexion angle were compared using Student-Fisher and Pearson statistical tests.

Results: Durations of intervention and tourniquet, sizes of implants used are identical in both series (with and without navigation). HKA (1.6 ° vs 1.2°), HKS (96.4 ° vs 96.6 °), tibial slope (2.8 ° vs 1.9 °) and femoral flexion (2.4 ° vs 3 °) have no significant difference; only the tibial mechanic angle (90.8 ° vs 89.4 °) is significantly different (P <0.05). The tendency to a moderate residual global valgus is most important with navigation, both for the femur and the tibia but not significantly.

Conclusions: Mechanical instrumentation of last generation can be as efficient in terms of precision as a navigation system but probably requires using an intramedullary tibial guide. Navigation remains the reference for precision, especially for tibia.

Total knee arthroplasty, navigation, standard instrumentation, precision
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings