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Alignment Deviation Between Bone Resection and Final Implant Positioning in Computer-Navigated Total Knee Arthroplasty

¹ Movement Analysis Laboratory (F.C., A.E., A.L., and S.G.) and the Department of Orthopaedic Surgery (F.C., A.E., L.B., V.D., and S.G.), Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy. E-mail address for A. Ensini: andrea.ensini{at}ior.it
² Department of Orthopaedic Surgery, Spital Oberengandin, CH 7503 Samedan, Switzerland

Investigation performed at the Department of Orthopaedic Surgery and Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy, and the Department of Orthopaedic Surgery, Spital Oberengandin, Samedan, Switzerland

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.

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° 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° in 4%, 3%, and 9% of the patients, respectively. Deviations as large as 3° 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.

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