Conventional Vs Pin-less Navigation Technique in Total Knee Replacement in Western Indian Population

Conventional Vs Pin-less Navigation technique in Total knee replacement in Western Indian population. Dr. Abhishek Shinde INTRODUCTION: Knee osteoarthritis represents a major health issue. Total knee replacement (TKR) has been established as standard therapy for severe osteoarthritis. Restoration of the mechanical axis is a main objective in TKR, as it is attributed to good long-term results. The success of this procedure as measured by pain relief, improved function, greater patient satisfaction, and implant longevity is predicated on a number of factors. These include prosthetic factors such as implant size, tribology, geometry, alignment, and position; patient factors including size, weight, activity, the existence of medical comorbidities, psychological, and physiological response to joint surgery; and surgical factors including surgical skill and experience, duration of surgery, appropriate preparation, and implantation of the prosthesis. The longevity of total knee prosthesis depends mostly on the correct alignment (Frontal, Sagittal& Axial) of the prosthetic components, soft tissue balancing& restoring the mechanical axis of lower limb (1). Recently, there has been greater focus on surgical technique and its relationship to implant performance and survival (2). In addition, greater attention is being paid to reducing surgical trauma through less invasive surgery and better implant positioning through computer-assisted surgery (CAS) (3). Numerous radiological and clinical studies have proven that computer-assisted total knee replacements (CAS-TKR) are more precise regarding limb alignment reconstruction as well as implant position compared to the conventional technique. In spite of its valuable advantages, the navigation technique is still not used as routine. (4) Main limitations are higher costs and additional time required for the surgical procedure. (5, 6) Further disadvantages are a prolonged training curve for new users (7, 8) and morbidity due to the placement of bony reference arrays such as fractures and infections (9, 10) The use of computer-assisted navigation is increasingly favored by Orthopaedics surgeons in total knee arthroplasty (TKA) because of reported advantages in literature including increased precision of individual component placement, (11) correlation with better knee function and quality of life (12) as well as a reduced number of outliers in obtaining neutral mechanical alignment. (13) Initial navigated systems used separate femoral and tibial diaphysis reference tracker pins which resulted in the occurrence of tracker pin-associated complications (14) In addition to a longer duration of surgery. (15) Pinless navigation systems were thus developed to harness the advantages in mechanical alignment of a computer-navigated TKA while essentially eliminating tracker pin-associated complications. The differences in surgical setup between a pinned versus painless computer-assisted surgery (CAS) setup in TKA surgery. The current literature comparing pinless-navigated TKA with CAS with conventional TKA revealed improved lower limb alignment and placement of components without significant difference in early post-operative function and range of movement although a longer duration of surgery was required. (16, 17, 18) Total knee replacement (TKR) surgery has become a commonly performed and highly successful surgical procedure. Recent innovations have improved both early and long term results. Navigation is the most significant advance in instrumentation for total knee replacement over the last decade. Although systemic reviews of TKA with CAS assisted by tracker pins have revealed no difference in clinical outcomes when compared to conventional TKA, there is a paucity of data describing the clinical outcomes in patients who underwent TKA with CAS using pinless navigation. The purpose of this study was to compare the clinical function, alignment, and survivorship of the component in primary total knee replacement (TKR) using navigation versus conventional surgical technique at 1- and 2-year follow-up. MATERIALS& METHODS: The patients included had osteoarthritis, Rheumatoid Arthritis or Ankylosing Spondylitis of the knee. All the patients were operated on by adult reconstruction surgeon trained in Conventional TKR& navigated TKR. A total of 16 patients met the inclusion criteria and were screened for enrolment in the study; all of them provided informed consent, all patients were randomized. After giving informed consent, 16 patients were randomized to undergo a navigated or conventional procedure. Unilateral as well as bilateral knees were included in this study. The assignment of the knee to navigation or not was done randomly and in which 12 knees were operated by computed assisted pinless navigation and remaining 15 knees were operated by conventional method of total knee replacement. Randomization was based on a permutation algorithm without stratification and admini