The Journal of Bone and Joint Surgery (American). 2007;89:236-243.
doi:10.2106/JBJS.F.00386
© 2007 The Journal of Bone and Joint Surgery, Inc.
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A Prospective, Randomized Study of Computer-Assisted and Conventional Total Knee Arthroplasty

Three-Dimensional Evaluation of Implant Alignment and Rotation

Georg Matziolis, Dr med1, Doerte Krocker, Dr med1, Ulrike Weiss1, Stephan Tohtz, Dr med1 and Carsten Perka, Prof Dr med1

1 Center for Musculoskeletal Surgery, Charité-University Medicine
Berlin, Charitéplatz 1, D-10117 Berlin, Germany. E-mail address for G. Matziolis: Georg.Matziolis{at}Charite.de. E-mail address for D. Krocker: Doerte.Krocker{at}Charite.de. E-mail address for U. Weiss: Ulrike.Weiss{at}Charite.de. E-mail address for S. Tohtz: Stephan.Tohtz{at}Charite.de. E-mail address for C. Perka: Carsten.Perka{at}Charite.de

Investigation performed at the Center for Musculoskeletal Surgery, Charité-University Medicine, Berlin, Germany

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Despite the use of modern instruments in total knee arthroplasty, component malalignment remains a problem. Whether a computer-assisted implantation technique can improve the accuracy of the spatial positioning of an implant is a matter of debate. The objective of this study was to determine whether computer-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning.

Methods: The spatial positioning of the implant in sixty total knee arthroplasties (thirty-two imageless computer-assisted and twenty-eight conventional implantations) was determined three-dimensionally with use of computed tomographic measurement, which allowed derotation and full extension of the knee in order to avoid projection-related imaging errors.

Results: The overall mechanical axis showed a range of between 4.8° of valgus and 6.6° of varus alignment in the frontal plane for conventionally implanted arthroplasty components compared with a significantly smaller range of between 2.9° of valgus and 3.1° of varus alignment for computer-assisted implantations (p = 0.004). In relation to the tibial implant, the mean deviation (and standard deviation) from the mechanical axis was 2.0° ± 1.7° for the conventional surgical method and 1.4° ± 0.9° for the navigated implantation. The rotational deviation from the referenced axis of the femoral component was between 3.3° of internal rotation and 5.0° of external rotation for the conventional implantation method, with a mean deviation of 0.1° ± 2.2°. Femoral components implanted with computer assistance showed a deviation of between 4.7° of internal rotation and 2.2° of external rotation, with a mean deviation of 0.3° ± 1.4°.

Conclusions: In this study, with our technique of filtering out projection-related imaging errors, computer-assisted implantation of total knee replacements improved the frontal and sagittal alignment of the femoral component but not of the tibial component. We found that the rotational alignment of the component was not improved through navigation by solely referencing to the epicondylar axis for the femur and the tuberosity for the tibia.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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