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USE OF KINEMATIC NAVIGATION IN PRIMARY AND SELECTED REVISION KNEE ARTHROPLASTY

Department of Orthopaedic Surgery, Charles University in Prague, 2nd Medical School, V Uvalu 84, 150 06, Prague 5, Czech Republic; Department of Orthopaedics and Trauma, Dumfries and Galloway Royal Infirmary, Bankend Rd., DG1 4AP, Dumfries, UK

Authors have been using kinematic computer navigation for a total knee replacement surgery since 2003. A contribution and advantage of computer navigation is well recognized. Exact guidance of both tibial and femoral osteotomy along with precise soft tissue balance respecting individual anatomic constitution is achieved by exact collection and computer evaluation of data by a use of special sensors and probes. Use of kinematic navigation in experienced hands minimizes deviation from physiological mechanical Mikulicz axis. This is considered the most important step to achieve a good long term outcome after total knee arthroplasty.

We have been recently using Brain Lab kinematic navigation system in both primary and revision knee arthroplasties. 200 primary and 20 revision knee arthroplasties are included in the retrospective 3 year follow up study. A navigated revision surgery is recently performed only in cases where the axial deformity does not exceed 10 degrees and where no significant bone loss is presented (bone defects less that cm). Standard cemented components are used in both primary and revision cases. A primary navigated knee arthroplasty had no exclusion criteria in the above study.

Technique: Medial patellar approach technique is used, navigation probes are placed in standard distal femoral and proximal tibial position. Data are collected using navigation probes and sensors. Loosen components and cement are removed next. Navigated proximal tibial osteotomy, distal femoral osteotomy and soft tissue balance are performed. Gentamycin cementing of standard components (tibia first) is performed at the end. A final verification of component balance and data storage terminates the procedure.

No need for conversion to a revision knee system using stem and wedges was noticed in the above series. Following the above inclusion criteria standard cemented implants were used only. We conclude that the use of navigation in cases of relatively uncomplicated knee revision arthroplasty guaranties good mid term outcome, good soft tissue balance, saves money on expensive knee revision systems and guaranties an alternative of second stage revision surgery with a use of extensive revision systems. Standard implant selection does not apply for those with deep bone defects and axial deformation higher than 10 degrees.

Correspondence should be addressed to Mr K Deep, General Secretary CAOS UK, Dept of Orthopaedics, Golden Jubilee National Hospital, Glasgow G81 4HX, Scotland. Email: caosuk{at}gmail.com