Published online Nov 18, 2015. doi: 10.5312/wjo.v6.i10.821
Peer-review started: April 9, 2015
First decision: June 4, 2015
Revised: June 25, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: November 18, 2015
Processing time: 216 Days and 18.4 Hours
AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty (TKA).
METHODS: We present an imageless navigation system for revision TKA, with optical point and tracker identification to assess kinematic and anatomical landmarks. The system automatically positions the cutting guides with a motorized cutting unit. The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts. The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA. However, there are some important differences. The most notable are: (1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes; (2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and (3) the suggested “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are taken into account to find the optimal femoral component position. We assessed the surgical technique, and accompanying software procedural steps, of the system, identifying any advantages or disadvantages that they present.
RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making. Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning. Furthermore, the femoral clamp provides a stable fixation mechanism for the motorized cutting unit. A stable clamp is paramount in the presence of periarticular bony defects. The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated, at which point any malalignments can be corrected. It also offers an optimal joint level position for implantation, and suggests a “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are considered. The surgeon can therefore make decisions intraoperatively to maximise alignment and, hence, outcomes. Based on the intraoperative findings of joint stability, the surgeon can modify the preoperative plan and switch from a constrained condylar system to a hinged version, or vice versa.
CONCLUSION: The system is flexible and easy to learn and allows improvements in workflow during TKA.
Core tip: The obscuring of bony landmarks by the previous implant, scar formation, the loss of bone stock and ligamentous insufficiency, make revision total knee arthroplasty very demanding. Current navigation systems do not typically allow reconstruction of the anatomic joint line, which is an important factor in implant survival, or compensation for the absence of classical landmarks. We present an imageless navigation system for revision total knee arthroplasty. The system automatically positions the cutting guides with a motorized cutting unit. We assessed the surgical technique, and accompanying software procedural steps, of the system, identifying any advantages or disadvantages that they present.