Clinical and radiographic outcomes of an accelerometer-based system for the tibial resection in total knee arthroplasty
Clinical and radiographic outcomes of an accelerometer-based system for the tibial resection in total knee arthroplasty
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DOI：
10.1007/s00264-014-2541-5
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发表时间：
2015-03-01
影响因子：
2.7
通讯作者：
Ferretti, Andrea
中科院分区：
文献类型：
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作者：
Iorio, Raffaele;Mazza, Daniele;Ferretti, Andrea
目的：基于加速度计的系统是一种便携式TKA手术导航系统，不需要像计算机辅助手术（CAS）那样使用大型计算机控制台进行配准和对准反馈。这项前瞻性研究的目的是确定基于加速度计的系统在胫骨部件定位中的准确性，并评估临床结果。方法：在2011年12月至2012年7月期间，共有53例原发性关节病患者连续前瞻性入选，采用手持式手术导航系统进行单侧TKA胫骨切除术。术前和术后，患者被要求填写疼痛视觉模拟量表（VAS）和膝关节损伤和骨关节炎结局评分（oos）。进行站立前后（AP）髋关节-膝关节-踝关节（HKA）和外侧膝关节-踝关节x线片，以确定内翻/外翻对齐以及胫骨部件相对于机械轴的后斜度。结果平均随访时间23个月。术前平均VAS为8.3 +/- 0.67，最终随访时平均VAS为1.2 +/- 0.57 （P < 0.001）。除KOOS运动评分（P = 0.075）和生活质量评分（P = 0.19）外，其余评分均较术前显著升高。术中，该系统提供的胫骨切除术前内翻/外翻对准的平均读数为0.55度+/- 0.43度。术后胫骨假体在冠状面上的平均x线对准度为0.65°+/- 0.59°，偏离理想对准（P < 0.05）。结论OrthAlign导航系统结合了计算机辅助手术系统的准确性和传统器械的易用性和熟悉性，同时避免了CAS技术的缺点和传统IM股骨对准系统的缺点。与患者特异性切割指南相比，该系统可以证明在最终冠状排列中异常值的发生率有所改善。
Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does not require the use of a large computer console for registration and alignment feedback as required in computer-assisted surgery (CAS). The purpose of this prospective study was to determine the accuracy of the accelerometer-based system in the tibial component positioning and also to evaluate clinical outcomes.Methods Between December 2011 and July 2012, a total of 53 consecutive patients with primary gonarthrosis were prospectively enrolled for unilateral TKA using a handheld surgical navigation system to perform the tibial resection. Pre-operatively and postoperatively, patients were asked to fill out a visual analogue scale for pain (VAS) and a knee injury and osteoarthritis outcome score (KOOS). Standing antero-posterior (AP) hip-knee-ankle (HKA) and lateral knee-to-ankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis.Results The mean duration of follow-up was 23 months. Average preoperative VAS was 8.3 +/- 0.67, which significantly improved to a mean 1.2 +/- 0.57 at final follow up (P < 0.001). All scores significantly increased compared with pre-operative scores, except for the KOOS sport component (P = 0.075) and quality of life (P = 0.19).Intra-operatively, the average reading provided by the system with regard to varus/valgus alignment before performing the tibial resection was 0.55 degrees +/- 0.43. The average postoperative radiographic alignment of the tibial component in the coronal plane was 0.65 degrees +/- 0.59 of deviation by the ideal alignment (P > 0.05).Conclusion This study demonstrates that the OrthAlign navigation system combines the accuracy of the computer-assisted surgery systems with the ease of use and familiarity of the traditional instruments while avoiding the drawbacks of the CAS technique and disadvantages of conventional IM femoral alignment systems. The system could demonstrate an improvement in the incidence of outliers in final coronal alignment, as compared with a patient-specific cutting guide.