Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA)

Nicola Biasca, Stephan Wirth, Matthias Bungartz
Knee 2009, 16 (1): 22-9
This study was designed to provide evidence that computer-navigated minimally invasive total knee arthroplasty (MIS CN-TKA) enables identical mechanical accuracy as conventional computer navigated total knee arthroplasty (CN-TKA) while reducing rehabilitation time and hospital stay of the patients. Two groups of 20 patients requiring total knee arthroplasty due to degenerative or posttraumatic knee osteoarthritis were included. Twenty consecutive patients received conventional CN-TKA and 20 consecutive patients received minimally invasive CN-TKA. Mechanical and rotational alignments were measured preoperatively and 6 months postoperatively on long-standing radiographs, on conventional coronal and sagittal views and on CT-scans of the knee. Length of skin incision, operating time, blood loss, length of hospital stay, postoperative ROM and HSS as well as KSS scores were determined. Postoperative mechanical axis improved significantly in both groups. Coronal and sagittal component positioning were accurate in both groups without significant differences. Rotational alignment showed the desired reproducible values without significant differences between the two groups. The posterior slope of the tibial component was significantly reconstructed to match the preoperative condition in both groups. The coronal alignment of the femoral and tibial components showed accurate reproducible results for implantation of both components in both groups. Length of skin incision was significantly shorter in the MIS CN-TKA. Duration of hospital stay was significantly reduced in the MIS CN-TKA group. Operating time and blood loss were similar in both groups. Postoperative ROM after the first 3 months was significantly higher in MIS CN-TKA, but after 6 months differences were minimal. Clinical outcome scores were identical for both groups 6 months after surgery. The advantages of CN-TKA are well known. Performing computer navigated TKA in combination with a minimally invasive approach in this study lead to a reduction of hospital stay and an initially increased ROM without differences in operating time and blood loss. Computer navigation in TKA preserves accurate coronal, sagittal and rotational components alignment even with a minimally invasive approach.

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