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Computer Navigation for Kinematic TKA

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One of the key backbones of Kinomatic is to restore the native, biomechanical alignment during a total knee arthroplasty (TKA) procedure. We empower our surgeons by giving them additional tools and information prior to the procedure so that the majority of the complexities of a TKA are known ahead of time. All the surgeon has to do is execute the plan. Computer navigation is a fundamental step in how we attain a well balanced, kinematic TKA for a patient. 

We would like to highlight a study of 100 patients undergoing a TKA (95 single TKA and 5 bilateral). One surgeon performed all of the operations. The goal of this study was to determine if native patient anatomy could be reproduced during a TKA procedure while producing satisfactory improvements in functional scores. Computer navigation was used for kinematic distal femoral and proximal tibial cuts for all 100 patients, although there isn’t much additional detail regarding the computer navigation method used. 

The average follow up was 2.4 years. Overall, the study found that the technique is reproducible, permitting recreating of the native anatomy while allowing for corrections when needed. Researchers saw the average WOMAC score (higher scores represent higher levels of pain, stiffness, and dissatisfaction) improve from 49.4 to 24.7. They also saw significant improvements in all KOOS scores (0-100 scale with 0 representing extreme problems and 100 representing no problems) with pain improving from 38.5 to 74.6, symptoms from 39.4 to 54.8, activities of daily living from 41.2 to 76, sport from 14.2 to 46.4, and quality of life from 24.1 to 71.9. 

Even though the sample size of this study is relatively small and there are still some limitations when evaluating broad, general use for all TKA eligible patients, the results are incredibly positive when it comes to overall satisfaction. The primary limitation to the effectiveness of kinematic TKA as an alignment philosophy is the lack of long-term efficacy and survivorship data. While we have seen numerous studies point to higher reported levels of satisfaction and function in native alignment methods for TKA vs. mechanical alignment, we still don’t have the 15-20 year follow up with many of these patients. However, as this study establishes, not all patients will recover normal knee function from a mechanical alignment TKA. Furthermore, dissatisfaction is reported in up to 20% of patients. This will still be a suitable procedure for some patients, but for the growing majority of joint replacement candidates, you could argue that this is simply an inferior approach for someone looking to regain normal knee function.

Personalized knee replacement technology is growing at a considerable rate. Computer navigation, 3D imaging, augmented reality and now virtual reality are all playing a role in advancing orthopedic surgery. As patients continue to look for the best possible procedure when considering a total joint replacement, we believe that personalized approaches will only continue to gain popularity and widespread acceptance among patients and the orthopedic community.

Original Article Referenced:

https://www.sciencedirect.com/science/article/pii/S1877056815003448

Kinematic TKA using navigation: Surgical technique and initial results

J.R.B.Hutt, M.-A.LeBlanc, V. Massé, M. Lavigne, P.-A. Vendittoli

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