Accuracy of Postoperative Leg Alignment and Postoperative
Parameters between Three Different Techniques,
Conventional, Computer-Assisted Navigation, and
Minimally Invasive Navigation Technique
Chumroonkiet Leelasestaporn MD, MBA1, Premstien Sirithanapipat BSc, MD1, Panithan Ruengsinsuwit MD1
Affiliation :
1 Vejthani TJR Center, Vejthani Hospital, Bangkok, Thailand
Objective : Compare conventional total knee arthroplasty [TKA], image-free computer-assisted navigation technique [CAN]-TKA,
and combined CAN and minimally invasive surgery technique [MIS-CAN] TKA in terms of postoperative leg alignment and the
following postoperative parameters, blood loss, time to start walking, pain score, and hospital stay. The secondary objective is to
compare safety and early adverse events between conventional, CAN, and MIS-CAN TKA.
Materials and Methods : Patients with osteoarthritis that underwent TKA in Vejthani TJR Center, Vejthani Hospital and satis(cid:976)ied
the eligibility criteria were included in the present study. The patients were classi(cid:976)ied intro three groups based on the surgical
procedure employed, Group 1, conventional surgical TKA technique, Group 2, CAN-TKA, and Group 3, MIS-CAN TKA.
Results : Comparison of mean mechanical axis between the three techniques showed that the conventional technique (mean 1.529,
SD 2.241) appeared to have more varus as compared to CAN (mean 0.795, SD 1.232) and MIS-CAN (mean 0.803, SD 1.304). However,
the mean differences were not statistically signi(cid:976)icant (p = 0.06). Accuracy of postoperative leg alignment (within ±3°) was best
observed in CAN group (98.28%) as compared to MIS-CAN group (93.15%) and conventional group (80.71%) (p<0.001). MIS-CAN
had the longest operative time (p<0.001) with a mean difference of about 10 minutes from conventional group (p<0.001) and CAN
group (p<0.001). Post-operative blood loss was lower for MIS-CAN group than conventional group (p<0.001), but no statistical
signi(cid:976)icant differences were seen between conventional and CAN groups (p = 0.19), and MIS-CAN and CAN groups (p = 0.06). In
the present study, operative time was not statistically different between CAN and conventional groups (p = 0.51). Time to start
walking, and length of hospital stay were lower for MIS-CAN group as compared to conventional (p<0.001) and CAN groups
(p<0.001). Complications or adverse events such as revision for any reason, pin tract fracture, deep infection, or deep venous
thrombosis or pulmonary embolism were not observed within two years post-surgery. Super(cid:976)icial infection was observed in one
patient (0.7%) in the conventional group and two patients (0.9%) in the MIS-CAN group.
Conclusion : Postoperative leg alignment accuracy (within ±3°) was shown to be best in CAN with conventional approach as
compared to MIS-CAN and conventional groups. In MIS-CAN group, computed assisted navigation can prevent increase in potential
outliers and improve accuracy of surgical procedure when compared with conventional group (p = 0.003), and can maintain
the bene(cid:976)it of MIS approach in term of less blood loss, shortest operative duration length of hospital stay, and time to ambulate
post-operation. CAN in TKA was proved to be safe without noted increase in complications within two years post-surgery.
Keywords : Total knee arthroplasty, Computer-assisted navigation, Minimally-invasive navigation
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