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Sirithanapipat P ,
Ruengsinsuwit P Materials and Methods: Patients with osteoarthritis that underwent TKA in Vejthani TJR Center, Vejthani Hospital and satisfied the eligibility criteria were included in the present study. The patients were classified 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 significant (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 significant 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. Superficial 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 benefit 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