Skip to main content
SpringerLink
Log in

Navigation in minimally invasive unicompartmental knee arthroplasty has no advantage in comparison to a conventional minimally invasive implantation

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Minimally invasive implantation of unicompartmental knee prostheses can shorten rehabilitation time and lead to better functional results than conventional implantation. Exact positioning of the implant should be achieved, as this is a factor for the long-term survival of the prosthesis, although malpositioning can result due to the poor intraoperative view when using the minimally invasive approach. Navigation of the unicompartmental prosthesis could lead to a better implant positioning without losing the advantages of a minimally invasive approach.

Materials and methods

The same unicondylar knee prosthesis was implanted in a total of 40 patients, of whom 20 were implanted using navigation (kinematic navigation) and 20 using a conventional technique. The operating time was assessed in both groups. The orientation of the tibial and femoral implants was assessed radiologically postoperatively. We analysed these results according to the optimal positioning range proposed by the manufacturer. Furthermore, we examined the clinical results with the knee society score (KSS).

Results

A good positioning of the prosthesis was observed in both techniques with only 11% of the radiologic measurements out of the proposed optimal range in each group. The operating time was significantly longer in the navigation group (17 min). The KSS did not differ between both groups at a follow-up of 16 resp. 18 months (navigated group: 184 points, conventional group: 178 points).

Conclusions

Navigation did not lead to a better positioning of the prosthesis than the conventional method and the operating time was longer. The clinical results were similar in both groups. The navigation may be a useful help for surgeons performing less unicompartmental knee arthroplasty using a minimally invasive approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mack MJ (2001) Minimally invasive and robotic surgery. JAMA 285:568–572

    Article  PubMed  CAS  Google Scholar 

  2. Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88:54–60

    Article  PubMed  CAS  Google Scholar 

  3. Repicci JA, Eberle RW (1999) Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc 8:20–27

    Google Scholar 

  4. Müller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19:296–301

    Article  PubMed  Google Scholar 

  5. Price AJ, Webb J, Topf H, Dodd CA, Goodfellow JW, Murray DW (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 16:970–976

    Article  PubMed  CAS  Google Scholar 

  6. Heyse TJ, Efe T, Rumpf S, Schofer MD, Fuchs-Winkelmann S, Schmitt J, Hauk C (2011) Minimally invasive versus conventional unicompartmental knee arthroplasty. Arch Orthop Trauma Surg (Epub ahead of print)

  7. Fisher DA, Watts M, Davis KE (2003) Implant position in knee surgery: a comparison of minimally invasive, open unicompartmental, and total knee arthroplasty. J Arthroplasty 18:2–8

    Article  PubMed  Google Scholar 

  8. Jenny JY, Boeri C (2003) Unicompartmental knee prosthesis implantation with a non-image-based navigation system: rationale, technique, case-control comparative study with a conventional instrumented implantation. Knee Surg Sports Traumatol Arthrosc 11:40–45

    PubMed  Google Scholar 

  9. Voss F, Sheinkop MB, Galante JO, Barden RM, Rosenberg AG (1995) Miller-Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations. J Arthroplasty 10:764–771

    Article  PubMed  CAS  Google Scholar 

  10. Cartier P, Sanouiller JL, Grelsamer RP (1996) Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 11:782–788

    Article  PubMed  CAS  Google Scholar 

  11. Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86-A:506–511

    PubMed  Google Scholar 

  12. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20:282–288

    Article  PubMed  Google Scholar 

  13. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20(2005):832–839

    Article  PubMed  Google Scholar 

  14. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186

    Article  PubMed  Google Scholar 

  15. Haaker RG, Wojciechowski M, Patzer P, Willburger RE, Senkal M, Engelhardt M (2006) Minimally invasive unicondylar knee replacement with computer navigation. Orthopade 35:1073–1079

    Article  PubMed  CAS  Google Scholar 

  16. Jung KA, Kim SJ, Lee SC, Hwang SH, Ahn NK (2010) Accuracy of implantation during computer-assisted minimally invasive Oxford unicompartmental knee arthroplasty: a comparison with a conventional instrumented technique. Knee 17:387–391

    Article  PubMed  Google Scholar 

  17. Lim MH, Tallay A, Bartlett J (2009) Comparative study of the use of computer assisted navigation system for axial correction in medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:341–346

    Article  PubMed  Google Scholar 

  18. Lonner JH, John TK, Conditt MA (2010) Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 468:141–146

    Article  PubMed  Google Scholar 

  19. Perlick L, Bathis H, Tingart M, Perlick C, Luring C, Grifka J (2004) Minimally invasive unicompartmental knee replacement with a nonimage-based navigation system. Int Orthop 28:193–197

    Article  PubMed  CAS  Google Scholar 

  20. Rosenberger RE, Fink C, Quirbach S, Attal R, Tecklenburg K, Hoser C (2008) The immediate effect of navigation on implant accuracy in primary mini-invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:1133–1140

    Article  PubMed  Google Scholar 

  21. Seon JK, Song EK, Park SJ, Yoon TR, Lee KB, Jung ST (2009) Comparison of minimally invasive unicompartmental knee arthroplasty with or without a navigation system. J Arthroplasty 24:351–357

    Article  PubMed  Google Scholar 

  22. Jenny JY, Müller PE, Weyer R, John M, Weber P, Ciobanu E, Schmitz A, Bacher T, Neumann W, Jansson V (2006) Navigated minimally invasive unicompartmental knee arthroplasty. Orthopedics 29:S117–S121

    PubMed  Google Scholar 

  23. Goslings JC, Gouma DJ (2008) What is a surgical complication? World J Surg 32:952

    Article  PubMed  CAS  Google Scholar 

  24. Dupont WD, Plummer WD (1998) Power and sample size calculations for studies involving linear regression. Control Clin Trials 19:589–601

    Article  PubMed  CAS  Google Scholar 

  25. Cossey AJ, Spriggins AJ (2005) The use of computer-assisted surgical navigation to prevent malalignment in unicompartmental knee arthroplasty. J Arthroplasty 20:29–34

    Article  PubMed  Google Scholar 

  26. Aldinger PR, Gill HS, Schlegel U, Schneider M, Clauss M, Goodfellow JW, Murray DW, Breusch SJ (2004) Is computer navigation a useful tool in unicompartmental knee arthroplasty? A pilot cadaver study. Orthopade 34:1094–1102

    Article  Google Scholar 

  27. Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 83:45–49

    Article  PubMed  CAS  Google Scholar 

  28. Gulati A, Pandit H, Jenkins C, Chau R, Dodd CA, Murray DW (2009) The effect of leg alignment on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 91:469–474

    Article  PubMed  CAS  Google Scholar 

  29. Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–285

    PubMed  Google Scholar 

  30. Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165

    Article  PubMed  Google Scholar 

  31. Utzschneider S, Goettinger M, Weber P, Horng A, Glaser C, Jansson V, Müller PE (2011) Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc (Epub ahead of print)

  32. Benjamin J (2006) Component alignment in total knee arthroplasty. Instr Course Lect 55:405–412

    PubMed  Google Scholar 

  33. Weber P, Schröder C, Utzschneider S, Jansson V, Müller PE (2011) A high tibial slope reduces wear in unicondylar knee arthroplasty [German]. In: Proceedings of the symposium for experimental orthopedics at the orthopedic clinic of the Ludwig–Maximilians University Munich. Unfallchirurg 114, p S13

  34. Diezi C, Wirth S, Meyer DC, Koch PP (2010) Effect of femoral to tibial varus mismatch on the contact area of unicondylar knee prostheses. Knee 17:350–355

    Article  PubMed  Google Scholar 

  35. Clarius M, Hauck C, Seeger JB, Pritsch M, Merle C, Aldinger PR (2010) Correlation of positioning and clinical results in Oxford UKA. Int Orthop 34:1145–1151

    Article  PubMed  Google Scholar 

  36. Hauptmann SM, Weber P, Glaser C, Birkenmaier C, Jansson V, Muller PE (2008) Free bone cement fragments after minimally invasive unicompartmental knee arthroplasty: an underappreciated problem. Knee Surg Sports Traumatol Arthrosc 16:770–775

    Article  PubMed  CAS  Google Scholar 

  37. Seon JK, Song EK, Yoon TR, Seo HY, Cho SG (2007) Tibial plateau stress fracture after unicondylar knee arthroplasty using a navigation system: two case reports. Knee Surg Sports Traumatol Arthrosc 15:67–70

    Article  PubMed  Google Scholar 

  38. Song MH, Kim BH, Ahn SJ, Yoo SH, Lee MS (2009) Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 24:1281–1284

    Article  PubMed  Google Scholar 

  39. Lewold S, Goodman S, Knutson K, Robertsson O, Lidgren L (1995) Oxford meniscal bearing knee versus the Marmor knee in unicompartmental arthroplasty for arthrosis: a Swedish multicenter survival study. J Arthroplasty 10:722–731

    Article  PubMed  CAS  Google Scholar 

  40. Hamilton WG, Collier MB, Tarabee E, McAuley JP, Engh CA Jr, Engh GA (2006) Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty. J Arthroplasty 21:98–107

    Article  PubMed  Google Scholar 

  41. Cerha O, Kirschner S, Gunther KP, Lutzner J (2009) Cost analysis for navigation in knee endoprosthetics. Orthopade 38:1235–1240

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors VJ and PEM were involved in the development of the surgical technique of the Univation and are paid consultant for Aesculap AG (Tuttlingen, Germany). This did, however, not influence the study design, the collection, analysis and interpretation, of data. Aesculap AG was also not involved in the writing of the manuscript and in the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany

    Patrick Weber, Sandra Utzschneider, Patrick Sadoghi, Matthias F. Pietschmann, Andreas Ficklscherer, Volkmar Jansson & Peter E. Müller

  2. Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria

    Patrick Sadoghi

Authors
  1. Patrick Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Utzschneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Sadoghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias F. Pietschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Ficklscherer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Volkmar Jansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter E. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter E. Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weber, P., Utzschneider, S., Sadoghi, P. et al. Navigation in minimally invasive unicompartmental knee arthroplasty has no advantage in comparison to a conventional minimally invasive implantation. Arch Orthop Trauma Surg 132, 281–288 (2012). https://doi.org/10.1007/s00402-011-1404-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1404-4

Keywords

Search

Navigation