TY - JOUR
T1 - Total knee arthroplasty with a computer-navigated saw
T2 - A pilot study knee
AU - Garvin, Kevin L.
AU - Barrera, Andres
AU - Mahoney, Craig R.
AU - Hartman, Curtis W.
AU - Haider, Hani
N1 - Funding Information:
The institution of four authors (KLG, AB, CWH, HH) has received, during the study period, funding from DePuy Orthopaedics Inc (Warsaw, IN, USA) and contract research funding from Arthrex Inc (Naples, FL, USA), Biomet Inc (Warsaw, IN, USA), Naval Health Research Center (San Diego, CA, USA), Empirical Testing Corp (Colorado Springs, CO, USA), Exactech Inc (Gainesville, FL, USA), Exponent Inc (Philadelphia, PA, USA), ESKA (Lübeck, Germany), Gruppo Bioimpianti (Milan, Italy), Kyocera Medical Corp (Osaka, Japan), Implanet (Martillac, France), Ortho Development (Draper, UT, USA), Otis Glebe Medical Research Foundation (Omaha, NE, USA), Renovis Surgical Technologies (Redlands, CA, USA), Smith & Nephew Inc (Memphis, TN, USA), SoftJoint (Iowa City, IA, USA), Stryker Orthopaedics (Mahwah, NJ, USA), Spine Medica (Atlanta, GA, USA), and Tornier (Montbonnot, France). The institution of one of the authors (CRM) has received, during the study period, funding from Smith & Nephew. One of the authors (KLG) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $100,001 to $1,000,000 from Biomet Inc. One of the authors (HH) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $10,000 to $100,000 from AMTI (Watertown, MA, USA), an amount of less than $10,000 from Arthrex, an amount of $10,000 to $100,000 from Biomet Inc, an amount of less than $10,000 from Orthopedic Surgical Manufacturers Association (Rockville, MD, USA), an amount of less than $10,000 from SoftJoint, and an amount of less than $10,000 from SI-BONE (San Jose, CA, USA).
PY - 2013/1
Y1 - 2013/1
N2 - Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94% of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.
AB - Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94% of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.
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U2 - 10.1007/s11999-012-2521-2
DO - 10.1007/s11999-012-2521-2
M3 - Article
C2 - 22972652
AN - SCOPUS:84871617568
SN - 0009-921X
VL - 471
SP - 155
EP - 161
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
IS - 1
ER -