Total knee arthroplasty with a computer-navigated saw

A pilot study knee

Kevin Lloyd Garvin, Andres Barrera, Craig R. Mahoney, Curtis W Hartman, Hani Haider

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94% of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.

Original languageEnglish (US)
Pages (from-to)155-161
Number of pages7
JournalClinical Orthopaedics and Related Research
Volume471
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Knee Replacement Arthroplasties
Knee
Bone and Bones
Thigh
Computer-Assisted Surgery
Learning Curve
Operative Time
Technology
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Total knee arthroplasty with a computer-navigated saw : A pilot study knee. / Garvin, Kevin Lloyd; Barrera, Andres; Mahoney, Craig R.; Hartman, Curtis W; Haider, Hani.

In: Clinical Orthopaedics and Related Research, Vol. 471, No. 1, 01.01.2013, p. 155-161.

Research output: Contribution to journalArticle

@article{2213027c3a85443aa6dfd1f10fd1ba4a,
title = "Total knee arthroplasty with a computer-navigated saw: A pilot study knee",
abstract = "Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94{\%} of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97{\%} of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.",
author = "Garvin, {Kevin Lloyd} and Andres Barrera and Mahoney, {Craig R.} and Hartman, {Curtis W} and Hani Haider",
year = "2013",
month = "1",
day = "1",
doi = "10.1007/s11999-012-2521-2",
language = "English (US)",
volume = "471",
pages = "155--161",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "1",

}

TY - JOUR

T1 - Total knee arthroplasty with a computer-navigated saw

T2 - A pilot study knee

AU - Garvin, Kevin Lloyd

AU - Barrera, Andres

AU - Mahoney, Craig R.

AU - Hartman, Curtis W

AU - Haider, Hani

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94% of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.

AB - Background: Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. Questions/Purposes: We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Methods: Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. Results: For the synthetic specimens, femoral coronal alignment was within ± 2 of neutral in 94% of the specimens. Sagittal alignment was within 0 to 5 of flexion in all specimens. Rotation was within ± 1 of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. Conclusions: TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. Clinical Relevance: NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.

UR - http://www.scopus.com/inward/record.url?scp=84871617568&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871617568&partnerID=8YFLogxK

U2 - 10.1007/s11999-012-2521-2

DO - 10.1007/s11999-012-2521-2

M3 - Article

VL - 471

SP - 155

EP - 161

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 1

ER -