Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty
Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty
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DOI：
10.2106/jbjs.g.00293
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发表时间：
2008-04-01
影响因子：
5.3
通讯作者：
Giannini, Sandro
中科院分区：
文献类型：
--
作者：
Catani, Fabio;Biasca, Nicola;Giannini, Sandro
背景资料：计算机导航全膝关节置换术旨在提高假体部件定位和下肢重新对齐的准确性。导航系统以截骨平面的最佳位置和方向为目标，但在获得这些位置和方向后，植入需要额外的手动手术操作，这可能会显著影响最终组件对线。本研究的目的是测量标准的胫骨和股骨部件的影响，骨切除术后使用导航control.Methods：九十一个主要的全膝关节置换术与图像自由膝关节导航系统所造成的对齐偏差。在手术过程中，通过系统的仪器化探针在三个平面中测量胫骨和股骨截骨的对准。最终胫骨和股骨部件植入骨水泥后，重复对线测量。这两个措施之间的对齐偏差被认为是与最终手动implantation of the components.Results的定位误差：骨切除和随后的植入物放置之间的对齐偏差> 1度在额状面的股骨和在额状面和矢状面的胫骨，分别为20%，11%和33%的患者。分别有4%、3%和9%的患者的偏差> 2度。在胫骨的矢状面（后斜坡）中发现了高达30的偏差。结论：在全膝关节置换术中，股骨和胫骨部件的定位主要涉及最终部件的骨水泥固定和压紧，无论切除平面有多精确，都会引入相当大的对准误差。因此，在计算机导航全膝关节置换术后，在骨水泥硬化之前仔细检查假体部件的对线将是有用的。
Background: Computer-navigated total knee arthroplasty is aimed at improving accuracy in the positioning of prosthetic components and realigning the lower limb. The optimal position and orientation of the bone resection planes are targeted by the navigation system, but, after these are obtained, additional manual surgical actions, which may considerably affect final component alignment, are necessary for implantation. The aim of this study was to measure the alignment deviation caused by standard impaction of the tibial and femoral components following bone resections with use of navigation control.Methods: Ninety-one primary total knee arthroplasties were performed with an image-free knee navigation system. The alignment of the tibial and femoral bone resections was measured in three planes during surgery by the instrumented probe of the system. The alignment measure was repeated after final tibial and femoral component implantation with cement. The alignment deviations between the two measures were considered the positioning error associated with the final manual implantation of the components.Results: The alignment deviations between the bone resections and the subsequent implant placement were > 1 degrees in the frontal plane of the femur and in the frontal and sagittal planes of the tibia in 20%, 11%, and 33% of the patients, respectively. The deviations were > 2 degrees in 4%, 3%, and 9% of the patients, respectively. Deviations as large as 30 were found at the tibia in the sagittal plane (the posterior slope).Conclusions: Positioning of the femoral and tibial components in total knee arthroplasty, which mainly involves cementation and impaction of the final components, can introduce a considerable error in alignment, regardless of how accurately the resection planes are made. After computer-navigated total knee arthroplasty, it would be useful therefore to check the alignment of the prosthetic component carefully before the cement hardens.