Experiences with computer navigated total knee arthroplasty.

The successful outcome of total knee arthroplasty (TKA) is very much dependent on precise positioning of the components. Inaccuracy may result in complaints as well as in early mechanical failure. Between March 2003 and September 2005, 69 TKA procedures were performed by the computer navigated technique. The postoperative outcome of this cohort was compared with the same number of TKAs done by the traditional technique. The lower limb anatomical axis was determined in all cases pre- and postoperatively by weight-bearing anteroposterior (AP) and lateral full length X-rays. The positions of femoral and tibial components were recorded. Comparing the data in the navigation group on the AP view, 96.6% of femoral and 96.9% of tibial components and on the lateral view in 95.4% of femoral and in 95.4% of tibial components, the overall postoperative axis in 95.4% fell in the range considered in the literature as optimal. In the traditional group on the AP view, 75.7% of femoral and 68.1% of tibial components and on the lateral view 81.8% of femoral and 63.6% of tibial components, the overall postoperative axis in 60.6% fell between the values considered optimal in the literature. It seems to be proven that the computer navigated total knee arthroplasty technique ensures positioning of components significantly more precisely compared with the traditional surgical method. Accuracy of navigation depends on the software used, on the correct detection of anatomical reference points, and on a potentially uneven thickness of the cement layer during final insertion of the components. The computer navigated technique does not substitute professional skill and experience, since it merely transmits information for the surgeon. The decision is in the hands of the doctor during the entire procedure. The real benefits of the computer navigated technique require further research and can be determined only after long-term analyses.

[Total knee arthroplasty in hemophilic arthropathy]. / Térdprotézis/beültetés arthropathia haemophilica esetén.

The case of a bilateral total knee arthroplasty in a hemophiliac patient is presented below. Postoperative blood loss, required factor substitution, complications after surgery were observed. Functional results were evaluated using the Hospital for Special Surgery Score. The pathophysiology of hemophilic arthropathy is reviewed also. The arthroplasties were performed using factor substitution and a tourniquet, posterior stabilized prosthesis was implanted on both sides. The average postoperative blood-loss was 700 ml. After the first procedure hemarthrosis occurred, other complications were not observed. Follow-up time was 164 weeks in the first case and 112 in the second. The average improvement in Hospital for Special Surgery Score was 34 points reaching 97,5 points postoperatively. Range of movement was 0-120 degrees on the right and 0-135 degrees on the left side. The authors emphasize the importance of the adequate hematological and anaesthetical background when performing surgery in a hemophiliac patient.