Accuracy of tibial component placement in unicompartmental knee arthroplasty performed using an accelerometer-based port
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KNEE
Accuracy of tibial component placement in unicompartmental knee arthroplasty performed using an accelerometer‑based portable navigation system Yoshio Matsui1 · Shinichi Fukuoka2 · Sho Masuda1 · Masanori Matsuura1 · Toshiaki Masada2 · Kenji Fukunaga2 Received: 20 June 2019 / Accepted: 7 October 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose There is a need for new devices to improve the accuracy of implantation in unicompartmental knee arthroplasties (UKAs). The accelerometer-based portable navigation system is expected to improve this accuracy. This study aimed to compare the accuracy of UKAs performed by the portable navigation system with that of the conventional method, and to investigate whether the portable navigation system can complement the surgeon’s experience. Methods The study comprised of 80 Oxford UKAs. Knees were divided into two groups based on the method of tibial osteotomy: the conventional group (37 UKAs performed by an experienced surgeon using the extra-medullary guide) and the portable navigation group (43 UKAs performed by 2 unaccustomed surgeons using the navigation system). The absolute error from the target angle on the coronal and sagittal plane was measured on whole lower leg X-ray. The incidence of outliers (> 3°) was compared between the groups using Fisher’s exact probability test. Results The incidences of outliers on the coronal plane were 41.0% (15 of 37 knees) in the conventional group and 9.3% (4 of 43 knees) in the portable navigation group (p 15° Flexion 15° varus deformity Clinical evidence of an incompetent ACL Symptomatic lateral tibiofemoral and patellofemoral joints or excessive wear Previous tibial or femoral osteotomy
ACL anterior cruciate ligament
limb alignment (e.g., high tibial osteotomy or tibial plateau fracture). In the conventional group, a senior orthopedic surgeon performed 37 UKAs. His experience included performing more than 300 UKAs, with an average of more than 20 knees per year. Tibial component alignment was controlled with the M icroplasty® system for the tibia, a conventional extra-medullary guide (Fig. 1), while the femoral component alignment was controlled with the M icroplasty® system for the femur as described in the manufacturer’s guidelines. The Microplasty® system for the femur is the manual surgical instrumentation setup attached to the intramedullary guide [19, 34, 37] (Fig. 2). The target alignment of the proximal tibia was perpendicular to the tibial mechanical axis in the coronal plane with an 8-degree posterior slope. In the portable navigation group, two surgeons unaccustomed to UKA performed 43 surgeries. Neither of the surgeons had performed UKAs in the last 5 years. They used the portable navigation system, KneeAlign 2 (OrthAlign, Inc., Aliso Viejo, CA, USA) to control the tibial component alignment. KneeAlign 2 is an accelerometer-based, portable navigation device used to perform the proximal tibial and distal femoral resections in TKA (Fig. 3). It does not r
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