Primary ArthroplastyLow Incidence of Postoperative Complications With Navigated Total Knee Arthroplasty
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.
References (29)
- et al.
Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation
J Arthroplasty
(2005) - et al.
Pin track induced fractures around computer-assisted TKA
Orthop Traumatol Surg Res
(2010) - et al.
Tibial shaft stress fractures resulting from placement of navigation tracker pins
J Arthroplasty
(2011) - et al.
Low incidence of postoperative complications due to pin placement in computer-navigated total knee arthroplasty
J Arthroplasty
(2010) - et al.
Low incidence of complications in computer assisted total knee arthroplasty—a retrospective review of 1596 cases
Knee
(2015) - et al.
Delayed femoral fracture through tracker pin site after navigated total knee arthroplasty
J Arthroplasty
(2011) - et al.
Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system
J Arthroplasty
(2008) - et al.
Femoral stress fracture after computer navigated total knee arthroplasty
Knee
(2006) - et al.
Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty
J Arthroplasty
(2008) - et al.
The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty
J Orthop Surg Res
(2010)
A comparison of radiological and computer navigation measurements of lower limb coronal alignment before and after total knee replacement
J Bone Joint Surg Br
Computer-assisted navigation increases precision of component placement in total knee arthroplasty
Clin Orthop Relat Res
Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study
Knee Surg Sports Traumatol Arthrosc
Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomised, clinical trial
J Bone Joint Surg Br
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2022, Journal of ArthroplastyCitation Excerpt :Finally, in a randomized controlled trial with a minimum follow-up of 10 years, there was no difference in complication rates between robotic-assisted and conventional TKA [7]. Although broader postoperative complication rates following robotic-assisted arthroplasty appear comparable to manual surgery, complications specific to the use of computer-assisted navigation and robotic assistance have been reported and remain a risk not typically applicable to conventional TJAs performed without the use of these technologies [19–23]. Modern robotic-assisted arthroplasty systems typically require multiple bone pins to be temporarily placed either within the surgical field or through separate percutaneous incisions (2 femoral and 2 tibial pins for TKA, 2-3 pelvic pins for THA).
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2022, KneeCitation Excerpt :PJI with CoNS infection was thought to result from pin tract infection; however, these are low-virulence bacteria. M.J. Brown et al. reported a low incidence of postoperative pin tract complications, including infections (0–0.47%) and fractures (0.065–0.160%) [32]. PJI with CoNS infection in the CAS-TKA group in this study accounted for 0.184% (2/1085), which was within the range of the percentages reported in the literature.
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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.