Primary Arthroplasty
Low Incidence of Postoperative Complications With Navigated Total Knee Arthroplasty

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Abstract

Background

A number of postoperative complications of navigated total knee arthroplasty (TKA) have been discussed in the literature, including tracker pin site infection and fracture. In this article, we discuss the low postoperative complication rate in a series of 3100 navigated TKAs and the overall complication rate in a systematic analysis of the literature.

Methods

Three thousand one hundred consecutive patients with navigated TKAs from 2001-2016 were retrospectively evaluated for complications specific to navigation. We discuss the 2 cases of postoperative fracture through tracker pin sites that we experienced and compare this systematically with the literature.

Results

Postoperatively, our 3100 patient cohort experienced a total of 2 fractures through pin sites for an incidence of 0.065%. One was a distal femoral fracture which was treated surgically, and the other was a proximal tibial fracture treated nonoperatively. Because of our incorporation of the tracker sites within our operative incision, there were no identifiable pin site infections, which others have noted at an incidence of 0.47%. Our 0.065% fracture rate compares favorably with the 0.16% rate of fracture published in the literature.

Conclusion

There is an extremely low risk of perioperative complications because of the instrumentation used in navigated TKA when using the Stryker Navigation System and 4.0 mm anchoring pins placed within the surgical incision.

Section snippets

Methods

We retrospectively reviewed the consecutive navigated TKAs performed at our institution by the 2 senior authors since we began using the Stryker Navigation System (Stryker Orthopaedics, Mahwah, NJ) in October 2001. We determined that there were 3100 cases performed, which had a minimum of 3-month follow-up, dating to March 2016.

Throughout the study period, our surgical incision contained the sites for both our femoral and tibial pins. At our institution, the surgeons use a 4-mm threaded

Case 1

T. C. is a 64-year-old female with a medical history significant for rheumatoid arthritis, mitral regurgitation, and rheumatic fever, who underwent a left computer-assisted cruciate-retaining TKA on June 1, 2015. She had received a right TKA 3 months previously by the same surgeon and successfully completed her rehabilitation. Her left knee demonstrated advanced arthritic changes with valgus deformity and had failed conservative management.

Intraoperatively, a medial parapatellar arthrotomy was

Results

We evaluated our 2 fractures out of 3100 cases, and retrospectively reviewed all navigated knee cases previously reported in the literature (Fig. 5). The incidence of fracture reported in the literature for a navigated TKA is 0.16%. There have been 12 cases of fractures out of 7383 total cases reported via PubMed and the Cochrane database in 6 total articles, as demonstrated in Table 1 [9], [10], [11], [12], [13], [14]. This does not take into account the number of case reports in the

Discussion

We demonstrate here the largest single report of computer-assisted TKAs, stretching from 2001-2016. In addition, we performed a systematic analysis of the existing literature to determine the incidence of postoperative complications inherent to computer-assisted TKA. To date, the literature demonstrates a rate of 0.16% for instrumentation-associated fractures and 0.47% for pin site infections in navigated TKAs. For our patient cohort, we had a 0.065% of instrumentation-associated fractures and

Conclusion

There is an extremely low risk of postoperative complications because of the instrumentation used in navigated TKA. Of the 3100 computer-assisted TKA performed at our institution, only 2 patients sustained a postoperative fracture involving the tracker pin site. One patient sustained a fall resulting in the injury. Combining our findings with the current published literature results in a sum of 24 fractures out of 7300 computer-assisted TKA.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.01.045.

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