Navigation-assisted total knee arthroplasty in knees with osteoarthritis due to extra-articular deformity

Purpose: Extra-articular post-traumatic deformity may make difficult the implantation of total knee arthroplasty (TKA). Staged surgical procedures, including femoral or tibial osteotomy, can be required to restore proper alignment. These procedures may be inappropriate because of high rate of complications. Intra-articular resection is an alternative procedure, but it is limited by the potential compromise of collateral knee ligaments. Conventional instrumentation cannot be used in patients with previous trauma and residual bone deformity. We want to assess whether computer-assisted surgery may be a good alternative to traditional techniques. Methods: Twenty consecutive TKAs were performed in 20 patients (12 men and 8 women) with knee arthritis due to extra-articular deformity. The mean age was 52 years. According to Moreland method, the mean (± standard deviation) of the pre-operative hip-knee-ankle angle was 10.4° ± 8.3° in varus. In all cases, an image-free knee navigation system was used because of the severe deformity or the presence of retained hardware that prevented the use of the intramedullary rod. The average follow-up was 3.1 years. Results: One month after surgery, the mean hip-knee-ankle angle was 0.8° ± 1.2° in varus. At follow-up, the Knee Society Score increased from an average of 48 pre-operatively to 91 (P <0.05) post-operatively, with over 90% of excellent and good results. Mean range of motion improved from a 7°-74° mean range pre-operatively to 0°-94° post-operatively. Conclusions: The general value of navigation systems in achieving accurate bone cuts and restoring the mechanical axis has been established in the literature for standard TKA but not yet for extra-articular deformity. Our findings at mid-term follow-up on a large cohort of these patients showed that these systems used for intra-articular resection are a very effective alternative to previous techniques. Level of evidence: Prospective study, Level IV.