Advertisement
Review Article| Volume 40, ISSUE 4, P537-563, October 2009

Minimally Invasive Computer-Navigated Total Knee Arthroplasty

      Modern computerized knee navigation systems aid surgeons both in the conventional and in the minimally invasive approach to optimize mechanical and rotational alignments of the components in all three planes to avoid any malrotation and/or any errors in coronal, sagittal, and axial alignments. The advantages of minimally invasive total knee arthroplasty can be achieved without loss of accuracy. There is increasing evidence of a positive correlation between accurate mechanical alignment after total knee arthroplasty and functional as well as quality-of-life patient outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Orthopedic Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Callaghan J.J.
        • O'Rourke M.R.
        • Iossi M.F.
        • et al.
        Cemented rotating-platform total knee replacement. A concise follow-up at a minimum of fifteen years.
        J Bone Joint Surg Am. 2005; 87: 1995-1998
        • Gill G.S.
        • Joshi A.B.
        Long-term results of kinematic condylar knee replacement: an analysis of 404 knees.
        J Bone Joint Surg Br. 2001; 83: 335-358
        • Pavone V.
        • Boettner F.
        • Fickert S.
        • et al.
        Total condylar knee arthroplasty: a long term follow-up.
        Clin Orthop Relat Res. 2001; 388: 18-25
        • Ritter M.A.
        • Berend M.E.
        • Meding J.B.
        • et al.
        Long-term follow-up of anatomic graduated components posterior cruciate-retaining total knee replacement.
        Clin Orthop Relat Res. 2001; 388: 51-57
        • Rodrigues J.A.
        • Bhende H.
        • Ranawat C.S.
        Total condylar knee replacement: a 20-year follow-up study.
        Clin Orthop Relat Res. 2001; 388: 10-17
        • Insall J.N.
        • Binazzi R.
        • Soudry M.
        • et al.
        Total knee arthroplasty.
        Clin Orthop Relat Res. 1985; 192: 13-22
        • Insall J.N.
        • Scuderi G.R.
        • Komistek R.D.
        • et al.
        Correlation between condylar lift-off and femoral component alignment.
        Clin Orthop Relat Res. 2002; 403: 143-152
        • Barrack R.L.
        • Schrader T.
        • Bertot A.J.
        • et al.
        Component rotation and anterior knee pain after total knee arthroplasty.
        Clin Orthop Relat Res. 2001; 392: 46-55
        • Sparmann M.
        • Wolke B.
        • Czupalla H.
        • et al.
        Positioning of total knee arthroplasty with and without navigation support.
        J Bone Joint Surg Br. 2003; 85: 830-835
        • Miller M.C.
        • Berger R.A.
        • Petrella A.J.
        • et al.
        Optimizing femoral component rotation in total knee arthroplasty.
        Clin Orthop Relat Res. 2001; 392: 38-45
        • Nagamine R.
        • White S.E.
        • McCarthy D.S.
        • et al.
        Effect of rotational malposition of the femoral component on knee stability kinematics after total knee arthroplasty.
        J Arthroplasty. 1995; 10: 265-270
        • Romero J.
        • Duronio J.F.
        • Sohrabi A.
        • et al.
        Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees.
        Clin Orthop Relat Res. 2002; 394: 243-253
        • Figgie H.E.
        • Goldberg V.M.
        • Heiple K.G.
        • et al.
        The influence of tibial-patellofemoral location on function of the knee in patients with posterior stabilized condylar knee prosthesis.
        J Bone Joint Surg Am. 1986; 68: 1035-1040
        • Piazza S.J.
        • Delp S.L.
        • Stulberg S.D.
        • et al.
        Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study.
        J Orthop Res. 1998; 16: 264-270
        • Ritter M.A.
        • Faris P.M.
        • Keating E.M.
        • et al.
        Postoperative alignment of total knee replacement. Its effect on survival.
        Clin Orthop Relat Res. 1994; 299: 153-156
        • Catani F.
        • Leardini A.
        • Ensini A.
        • et al.
        The stability of cemented tibial component of total knee arthroplasty: posterior cruciate-retaining versus posterior-stabilized design.
        J Arthroplasty. 2004; 19: 775-782
        • Jeffery R.S.
        • Morris R.W.
        • Denham R.A.
        Coronal alignment after total knee replacement.
        J Bone Joint Surg Br. 1991; 73: 709-714
        • Rand J.A.
        • Coventry M.B.
        Ten-year evaluation of geometric total knee arthroplasty.
        Clin Orthop Relat Res. 1988; 232: 168-173
        • Matziolis G.
        • Krocher D.
        • Weiss U.
        • et al.
        A prospective, randomized study of computer-assisted and conventional total knee arthroplasty.
        J Bone Joint Surg Am. 2007; 89: 236-243
        • Lotke P.A.
        • Ecker M.L.
        Influence of positioning of prosthesis in total knee replacement.
        J Bone Joint Surg Am. 1977; 59: 77-79
        • Nabeyama R.
        • Matsuda S.
        • Miura H.
        • et al.
        The accuracy of image-guided knee replacement based on computed tomography.
        J Bone Joint Surg Br. 2004; 86: 366-371
        • Sharkey P.F.
        • Hozack W.J.
        • Rothman R.H.
        • et al.
        Insall Award paper: why are total knee arthroplasties failing today?.
        Clin Orthop Relat Res. 2002; 404: 7-13
        • Stulberg S.
        • Loan P.
        • Sarin V.
        Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients.
        J Bone Joint Surg Am. 2002; 84: 90-98
        • Chauhan S.K.
        • Scott R.G.
        • Breidahl W.
        • et al.
        Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomized, prospective trial.
        J Bone Joint Surg Br. 2004; 86: 372-377
        • Stöckl B.
        • Nogler M.
        • Rosiek R.
        • et al.
        Navigation improved accuracy of rotational alignment in total knee arthroplasty.
        Clin Orthop Relat Res. 2004; 426: 180-186
        • Bäthis H.
        • Perlick L.
        • Tingart M.
        • et al.
        Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with conventional technique.
        J Bone Joint Surg Br. 2004; 86: 682-687
        • Martin A.
        • Wohlgenannt O.
        • Prenn M.
        • et al.
        Imageless navigation for TKA increased implant accuracy.
        Clin Orthop Relat Res. 2007; 460: 178-184
        • Ensini A.
        • Catani F.
        • Leardini A.
        • et al.
        Alignments and clinical results in conventional and navigated total knee arthroplasty.
        Clin Orthop Relat Res. 2007; 457: 156-162
        • Mielke R.K.
        • Clemens U.
        • Jens J.H.
        • et al.
        Navigation in knee endoprosthesis implantation: preliminary experience and prospective comparative study with conventional implantation technique.
        Z Orthop Ihre Grenzgeb. 2001; 139: 109-116
        • Jenny J.Y.
        • Boeri C.
        Navigated implantation of total knee endoprosthesis: a comparative study with conventional instruments.
        Z Orthop Ihre Grenzgeb. 2001; 139: 117-119
        • Bonutti P.M.
        • Mont M.A.
        • McMahon M.
        • et al.
        Minimally invasive total knee arthroplasty.
        J Bone Joint Surg Am. 2004; 86: 26-32
        • Repicci J.A.
        Mini-invasive knee unicompartmental arthroplasty: bone-sparing technique.
        Surg Technol Int. 2003; 11: 282-286
        • Dalury D.F.
        • Dennis D.A.
        Mini-incision total knee arthroplasty can increase risk of component malalignment.
        Clin Orthop Relat Res. 2005; 440: 77-81
        • Insall J.N.
        Choices and compromises in total knee arthroplasty.
        Clin Orthop Relat Res. 1988; 226: 43-48
        • Tria A.J.
        • Coon T.M.
        Minimal incision total knee arthroplasty.
        Clin Orthop Relat Res. 2003; 416: 185-190
        • Laskin R.S.
        New techniques and concepts in total knee replacement.
        Clin Orthop Relat Res. 2003; 416: 151-153
        • Bonutti P.M.
        • Neal D.J.
        • Kestler M.A.
        Minimal incision total knee arthroplasty using the suspended leg technique.
        Orthopedics. 2003; 26: 899-903
        • Daubresse F.
        • Vajeu C.
        • Loquet J.
        Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital.
        Acta Orthop Belg. 2005; 71: 710-713
        • King J.
        • Stamper D.L.
        • Schaad D.C.
        • et al.
        Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty: assessment of the learning curve and the post-operative recuperative period.
        J Bone Joint Surg Am. 2007; 89: 1497-1503
        • Laskin R.S.
        Minimally invasive total knee arthroplasty: the results justify its use.
        Clin Orthop Relat Res. 2005; 440: 54-59
        • Boerger T.O.
        • Aglietti P.
        • Mondanelli N.
        • et al.
        Mini-subvastus versus parapatellar approach in total knee arthroplasty.
        Clin Orthop Relat Res. 2005; 440: 82-87
        • Karpman R.R.
        • Smith H.L.
        Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study.
        J Arthroplasty. 2008; 24: 681-688
        • Choong P.F.
        • Dowsey M.M.
        • Stoney J.D.
        Does accurate anatomical alignment result in better function and quality of life? A prospective randomized controlled trial comparing conventional and computer-assisted total knee arthroplasty.
        J Arthroplasty. 2008; 24: 560-569
        • Longstaff L.M.
        • Sloan K.
        • Stamp N.
        • et al.
        Good alignment after total knee arthroplasty leads to faster rehabilitation and better function.
        J Arthroplasty. 2008; 24: 570-578
        • Scuderi G.R.
        • Tenholder M.
        • Capeci C.
        Surgical approaches in mini-incision total knee arthroplasty.
        Clin Orthop Relat Res. 2004; 428: 61-67
        • Hofmann A.A.
        • Plaster R.L.
        • Murdock L.E.
        Subvastus (southern) approach for primary total knee arthroplasty.
        Clin Orthop Relat Res. 1991; 269: 70-77
        • Engh G.A.
        • Holt B.T.
        • Parks N.L.
        A midvastus muscle-splitting approach for the total knee arthroplasty.
        J Arthroplasty. 1997; 12: 322-331
        • Seyler T.M.
        • Bonutti P.M.
        • Slif D.U.
        • et al.
        Minimally invasive lateral approach to total knee arthroplasty.
        J Arthroplasty. 2007; 22: 21-26
        • Labat G.
        Regional anesthesia: Its technique and clinical applications: regional anesthesia.
        2nd edition. W.B. Saunders, Philadelphia1924 (p. 45–55)
        • Winnie A.P.
        • Ramamurthy S.
        • Durrani Z.
        The inguinal paravascular technique of lumbar plexus anesthesia: the ‘3-in-1 block’.
        Anesth Analg. 1973; 52: 989-996
        • Beck G.P.
        Anterior approach to sciatic nerve block.
        Anesthesiology. 1963; 24: 222-224
        • Pham Dang C.
        Midfemoral block: a new lateral approach to the sciatic nerve.
        Anesth Analg. 1999; 88: 1426
      1. Meier G. Der kontinuierliche anteriore Ischidicuskatheter (KAI). In: Mehrkens HH, Büttner J (Hrsg). Kontinuerliche periphere Leitungsblockade. Acris Verlag, München, 1999:47–8 [in German].

      2. Meier G. Der distale Ischiadicuskatheter (DIK). In: Mehrkens HH, Büttner J (Hrsg). Kontinuerliche periphere Leitungsblockade. Acris Verlag, München, 1999:43–6 [in German].

        • Dalury D.F.
        Observations of the proximal tibia in total knee arthroplasty.
        Clin Orthop Relat Res. 2001; 389: 150-155
        • Eckhoff D.G.
        • Metzger R.G.
        • Vandewalle M.V.
        Malrotation associated with implant alignment technique in total knee arthroplasty.
        Clin Orthop Relat Res. 1995; 3211: 28-31
        • Biasca N.
        • Wirth S.
        • Bungartz M.
        Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MISTKA).
        Knee. 2009; 16: 22-29
        • Ranawat C.S.
        • Insall J.
        • Shine J.
        Duo-condylar knee arthroplasty: hospital for special surgery design.
        Clin Orthop Relat Res. 1976; 120: 76-82
        • Insall J.N.
        • Dorr L.D.
        • Scott R.D.
        • et al.
        Rationale of the knee society clinical rating system.
        Clin Orthop Relat Res. 1989; 248: 13-14
        • Chin P.L.
        • Yang K.Y.
        • Yeo S.J.
        • et al.
        Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique.
        J Arthroplasty. 2005; 20: 618-626
        • Ewald F.C.
        The knee society total knee arthroplasty roentgenographic evaluation and scoring system.
        Clin Orthop Relat Res. 1989; 248: 9-12
        • Yoo J.H.
        • Chang C.B.
        • Shin K.S.
        • et al.
        Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes.
        J Arthroplasty. 2008; 23: 586-592
        • Berger R.A.
        • Rubash H.E.
        • Seel M.J.
        • et al.
        Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis.
        Clin Orthop Relat Res. 1993; 286: 40-47
        • Bauwens K.
        • Matthes G.
        • Wich M.
        • et al.
        Navigated total knee replacement: a meta-analysis.
        J Bone Joint Surg Am. 2007; 89: 261-269
        • Mason J.B.
        • Fehring T.K.
        • Estok R.
        • et al.
        Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery.
        J Arthroplasty. 2007; 22: 1097-1106
        • Jenny J.Y.
        • Clemens U.
        • Kohler S.
        • et al.
        Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system.
        J Arthroplasty. 2005; 20: 832-839
        • Haaker R.G.
        • Stockheim M.
        • Kamp M.
        • et al.
        Computer-assisted navigation increased precision of component placement in total knee arthroplasty.
        Clin Orthop Relat Res. 2005; 433: 152-159
        • Molfetta L.
        • Caldo D.
        Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up.
        Knee. 2008; 15: 75-79
        • Decking R.
        • Markmann Y.
        • Fuchs J.
        • et al.
        Leg axis after computer-navigated total knee arthroplasty: a randomized trial comparing computer-navigated and manual implantation.
        J Arthroplasty. 2005; 20: 282-288
        • Kim Y.H.
        • Kim J.S.
        • Yoon S.H.
        Alignment and orientation of the components in total knee replacement with and without navigation support.
        J Bone Joint Surg Br. 2007; 89: 471-476
        • Malik M.H.
        • Wadia F.
        • Porter M.L.
        Preliminary radiological evaluation of the Vector Vision CT-free knee module for implantation of the LCS knee prosthesis.
        Knee. 2007; 14: 19-21
        • Siston R.A.
        • Patel J.J.
        • Goodman S.B.
        • et al.
        The variability of femoral rotational alignment in total knee arthroplasty.
        J Bone Joint Surg Am. 2005; 87: 2276-2280
        • Catani F.
        • Biasca N.
        • Ensini A.
        • et al.
        Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty.
        J Bone Joint Surg Am. 2008; 90: 765-771
        • Hart R.
        • Janecek M.
        • Chaker A.
        • et al.
        Total knee arthroplasty implanted with and without kinematic navigation.
        Int Orthop. 2003; 27: 366-369
        • Oberst M.
        • Bertsch C.
        • Wurstlin S.
        • et al.
        CT analysis of leg alignment after conventional versus navigated knee prosthesis implantation.
        Unfallchirurg. 2003; 106: 941-948
        • Olcott C.W.
        • Scott R.D.
        The Ranawat Award. Femoral component rotation during total knee arthroplasty.
        Clin Orthop Relat Res. 1999; 367: 39-42
        • Chauhan S.K.
        • Clark G.W.
        • Lloyd S.
        • et al.
        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: 818-823
        • Siston R.A.
        • Giori N.J.
        • Goodman S.B.
        • et al.
        Surgical navigation for total knee arthroplasty: a perspective.
        J Biomech. 2007; 40: 728-735
        • Catani F.
        • Biasca N.
        • Ensini A.
        • et al.
        Tibial and femoral joint line restoration after navigated total knee arthroplasty.
        J Bone Joint Surg Am. 2009; ([in review])
        • Van Damme G.
        • Defoort K.
        • Ducoulombier Y.
        • et al.
        What should the surgeon aim for when performing computer-assisted total knee arthroplasty?.
        J Bone Joint Surg Am. 2005; 87: 52-58
        • Tokuhara Y.
        • Kadoya Y.
        • Nakagawa S.
        • et al.
        The flexion gap in normal knees: an MRI study.
        J Bone Joint Surg Br. 2004; 86: 1133-1136
        • Todo S.
        • Kadoya Y.
        • Moilanen T.
        • et al.
        Anteroposterior and rotational movement of the femur during knee flexion.
        Clin Orthop. 1999; 362: 162-170
        • Hill P.F.
        • Vedi V.
        • Williams A.
        • et al.
        Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI.
        J Bone Joint Surg Br. 2000; 82: 1196-1198
        • Iwaki H.
        • Pinskerova V.
        • Freeman M.A.R.
        Tibiofemoral movement 1: the shapes and relative movement of the femur and tibia in the unloaded cadaver knee.
        J Bone Joint Surg Br. 2000; 82: 1189-1195
        • Nakagawa S.
        • Kadoya Y.
        • Todo S.
        • et al.
        Tibiofemoral movement 3: full flexion in the living knee studied by MRI.
        J Bone Joint Surg Br. 2000; 82: 1199-1200
        • Moore T.H.
        • Meyer M.H.
        Apparatus to position knees for varus-valgus stress roentgenograms.
        J Bone Joint Surg Am. 1977; 59: 984
        • Takahashi T.
        • Wada Y.
        • Yamamoto H.
        Soft tissue balancing with pressure distribution during total knee arthroplasty.
        J Bone Joint Surg Br. 1997; 79: 235-239
        • Stahelin T.
        • Kessler O.
        • Pfirmann C.
        • et al.
        Fluoroscopy assisted stress radiography for varus-valgus stability assessment in flexion after total knee arthroplasty.
        J Arthroplasty. 2003; 18: 513-515
        • Oliver J.H.
        • Coughlin L.P.
        Objective knee evaluation using the Genucum knee analysis system: clinical implications.
        Am J Sports Med. 1987; 15: 571-578
      3. Wirth S, Biasca N. Joint laxity in navigated total knee arthroplasty. Presented at the 2006 Computer Assisted Orthopaedic Surgery, 5th International Annual Meeting of CAOS, Helsinki, Finland, June 19–22, 2005.

        • Stulberg S.D.
        • Yafffe M.A.
        • Koo S.S.
        Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study.
        J Bone Joint Surg Am. 2006; 88: 47-54
        • Haas S.B.
        • Cook S.
        • Beksac B.
        Minimally invasive total knee replacement through a mini midvastus approach: a comparative study.
        Clin Orthop Relat Res. 2004; 428: 68-73
        • Haas S.B.
        • Manitta M.A.
        • Burdick P.
        Minimally invasive total knee arthroplasty: the mini midvastus approach.
        Clin Orthop Relat Res. 2006; 452: 112-116
        • Lingard E.A.
        • Katz J.N.
        • Wright R.J.
        • et al.
        Validity and responsiveness of the knee society clinical rating system in comparison with the SF-36 and WOMAC.
        J Bone Joint Surg Am. 2001; 83: 1856-1864