Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect coronal alignment

Abstract

Background: Few studies have compared the effect of different computer navigation systems on postoperative alignment in patients who have had total knee arthroplasty (TKA). We examined 2 computed tomography (CT)-free computer navigation systems by comparing the accuracy of intraoperative measurements to postoperative alignment. Methods: Patients underwent unilateral TKA performed by a single surgeon using 1 of 2 CT-free navigation systems. We compared final intraoperative tibial and femoral coronal angles and mechanical axis with the same angles measured on standing postoperative radiographs. Results: Groups of 31 and 50 patients underwent TKA with the 2 systems, respectively. We noted a significant difference in the coronal tibial implant angle (1.29° ± 1.35°) and in the mechanical axis (1.59° ± 2.36°) for one navigation system (both p < 0.001), while only the coronal tibial implant angle showed a significant difference (1.17° ± 1.65°, p < 0.001) for the second system. The number of radiographic outliers also significantly differed. A significantly higher proportion (32%; p < 0.01) of patients in the second cohort exhibited unacceptable malalignment compared with the first cohort (24%). Conclusion: Navigation systems for TKA continue to increase in sophistication and popularity. Owing to the significant difference in the proportion of alignment outliers in the 2 navigation systems tested in this study, orthopedic surgeons should not consider all TKA navigation systems equivalent. Additional investigations are needed to compare the accuracy of a variety of CT-free and CT-based navigation systems and to confirm our finding that accuracy is system-dependent.