Computer-Assisted Navigation—Total Knee Arthroplasty (2022)

ScienceDirect

RegisterSign in

ViewPDF

  • Access throughyour institution

Operative Techniques in Orthopaedics

Volume 22, Issue 4,

December 2012

, Pages 176-181

(Video) Computer Assisted Navigation for Total Knee Replacement

Computer-assisted total knee arthroplasty (TKA) has been implemented to improve the accuracy of implant positioning and limb alignment. Studies have shown several benefits of computer-assisted TKA over conventional TKA. However, the technology is not without potential pitfalls. The following article is a technique guide for the use of computer-assisted navigation for TKA.

Section snippets

Setup

For a right-handed surgeon, the computer navigation system is loaded and positioned in the room on the patient's left. This keeps the line of sight from the trackers to the detector open when the surgeon is standing in his position. Patient data such as side and name can be entered into the system to store the data. The trackers and the pointer are registered by the operating room technician so that they are validated and ready for use.

Approach

The patient is positioned supine, and the leg is sterilely

Discussion

The immediate advantages of the CAS-TKA for the surgeon include real-time visual feedback regarding bony resections and limb alignment. Furthermore, it is a valuable teaching tool for trainees and can be used in research. It is a skill that is obtainable with a modest learning curve; a general orthopedic surgeon can learn CAS-TKA and reproduce the results of an expert after only 16 cases.9 In comparison of CAS-TKA with conventional TKA, there is no difference in blood loss, hospital length of

References (11)

  • P.F. Choong et al.Does accurate anatomical alignment result in better function and quality of life?Comparing conventional and computer-assisted total knee arthroplasty

    J Arthroplasty

    (2009)

  • J.B. Mason et al.Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery

    (Video) Computer Assisted Navigation Helps with Knee Replacement Surgery

    J Arthroplasty

    (2007)

  • P. Merloz et al.Computer-assisted surgery: automated screw placement in the vertebral pedicle [in French]

    Chirurgie

    (1998)

  • K.A. Krackow et al.

    A new technique for determining proper mechanical axis alignment during total knee arthroplasty: Progress toward computer-assisted TKA

    Orthopedics

    (1999)

  • R.S. Jeffery et al.

    Coronal alignment after total knee replacement

    J Bone Joint Surg Br

    (1991)

There are more references available in the full text version of this article.

Recommended articles (6)

  • Research article

    Dorsal Distal Radius Pedicled Vascularized Bone Grafting for Avascular Necrosis of the Carpus

    Operative Techniques in Orthopaedics, Volume 22, Issue 3, 2012, pp. 151-158

    (Video) Computer Navigation in Total Knee Arthroplasty - Marc Connell, M.D.

    Although avascular necrosis can occur in any of the carpal bones, they more commonly affect the scaphoid (Preiser disease) and the lunate (Kienbock disease). Many revascularization options have been described, mostly pedicled vascularized bone grafts from the volar and dorsal aspect of the distal radius and carpus. Pedicled vascularized bone grafts from the dorsal distal radius is rooted on a consistent and rich arterial network that allows for many different donor sites based on the location of the recipient carpal bone. In the treatment of Preiser disease and Kienbock disease, we prefer to use the 1,2-intercompartmental supraretinacular artery and the 4th + 5th extensor compartment artery pedicled dorsal distal radius bone grafts.

  • Research article

    Coping with Extensive Bone Loss: The Use of Megaprosthetic Replacements for Difficult Knee Revisions

    Operative Techniques in Orthopaedics, Volume 22, Issue 4, 2012, pp. 228-235

    Dealing with extensive bone loss is one of the more difficult challenges in revision total knee arthroplasty. Occasionally, osteolysis, bone destruction due to infection, or fracture cause destruction that precludes the use of standard revision components. In this scenario, megaprosthetic reconstruction may be considered. Used for years in oncologic reconstructions, modular endoprostheses allow any amount of bone to be substituted. In the knee, either distal femoral or proximal tibial replacements can be performed. Rehabilitation of a distal femoral replacement parallels that of knee revision, whereas proximal tibial rehabilitation is somewhat different owing to the reconstruction of the extensor mechanism. Although somewhat different from that arthroplasty, the technique for bony resection and megaprosthetic reconstruction is applicable to arthroplasty surgeons or general orthopedic surgeons with revision arthroplasty experience. This reconstructive technique should be within the armamentarium of any surgeon who performs complex revision arthroplasty surgery.

  • Research article

    Free Medial Femoral Condyle Vascularized Bone Grafting for Scaphoid Nonunions with Proximal Pole Avascular Necrosis and Carpal Collapse

    Operative Techniques in Orthopaedics, Volume 22, Issue 3, 2012, pp. 159-166

    Treating scaphoid nonunions complicated by avascular necrosis and collapse with humpback deformity has proven challenging. Conventional nonvascularized interposition grafts restore the structural architecture, but fail to restore the vascular supply to the scaphoid. Pedicled inlay grafts restore blood flow, but fail to correct the humpback deformity or restore scaphoid length. Restoration of both vascularity and geometry is critical for promoting bony union. The free vascularized medial femoral condyle bone graft provides both and has proven successful in treating this problematic subset of scaphoid nonunions. The rationale, indications, contraindications, anatomical basis, and technique of scaphoid preparation, bone graft harvest, insetting, fixation, and microvascular anastomosis are presented for the treatment of scaphoid nonunions with avascular necrosis and carpal collapse.

  • Research article

    (Video) COMPUTER NAVIGATION TOTAL KNEE REPLACEMENT

    Patellofemoral Arthritis

    Operative Techniques in Orthopaedics, Volume 22, Issue 4, 2012, pp. 196-202

    Patellofemoral arthroplasty represents a modern surgical treatment for patients with isolated patellofemoral arthritis. This procedure is less invasive than total knee arthroplasty and preserves the patients' ligaments, menisci, and most of their native knee joint. Even though it raised much controversy in its early days due to poor results, newer-generation implants have led to lower complications rates and improved outcomes. This is mainly owing to the use of onlay implants, which truly replace the patellofemoral compartment. Thorough patient selection is crucial to optimize outcomes. Progression of arthritis in the tibiofemoral compartments currently constitutes the most frequently seen complication. Recent advances include the use of computer navigation and the combination of patellofemoral arthroplasty with other minimally invasive procedures to address more extensive disease of the knee joint.

  • Research article

    Arthroscopic Versus Open Dorsal Ganglion Cyst Excision

    Operative Techniques in Orthopaedics, Volume 22, Issue 3, 2012, pp. 131-135

    Dorsal ganglion cysts can be approached with either open or arthroscopic surgical treatment. With open excision, there are concerns for wrist stiffness, poor aesthetics, and cyst recurrence. Attempts to mitigate unsatisfactory results have motivated the application of wrist arthroscopy in treating these cysts. Proponents of the arthroscopic technique cite excellent outcome after prospective clinical studies, suggesting that arthroscopic excision may be superior to open excision with a notably negligible risk of recurrence. However, long-term randomized clinical outcomes, including a direct comparison of the relative costs of treatment, are still lacking. Although arthroscopic excision is arguably becoming widely accepted, open excision is a straightforward surgical technique, and the choice between the two methods remains one of surgeon experience and/or patient preference.

  • Research article

    Unicompartmental Knee Replacement With New Oxford Instruments

    Operative Techniques in Orthopaedics, Volume 22, Issue 4, 2012, pp. 189-195

    The Oxford unicompartmental knee arthroplasty was developed for the treatment of anteromedial osteoarthritis of the knee. Following strict adherence to the clinical indications, this mobile-bearing device has shown >90% survivorship at 20 years and good to excellent clinical results after 10 years. The addition of small incision surgery to the Oxford technique along with rapid recovery protocols has resulted in quicker functional recovery with less morbidity and mortality, thus making the procedure truly minimally invasive compared with total knee replacement. The most recent evolutionary change to the Oxford technique has been the addition of new instrumentation (Oxford Microplasty) that allows for more reproducible execution of the operation, which might improve the long-term success of the surgery. This article outlines the Oxford surgical technique using the Oxford Microplasty instruments.

View full text

Copyright © 2012 Elsevier Inc. All rights reserved.

(Video) Computer Navigation in Total Knee Arthroplasty by Dr Darren Webb

FAQs

What is total knee arthroplasty with navigation? ›

Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references.

Is robotic-assisted knee replacement better? ›

Yes — robotic surgery has been shown to deliver better results vs. traditional knee replacement. Studies have shown surgeries performed with robotics offer more accurate results. The less trauma on the bone and tissue, the better the results, and robotic assistance allows for precision that reduces traumatic areas.

What is computer assisted navigation? ›

Description. Computer-assisted navigation (CAN) is the application of computer tracking systems to assist with alignment in a variety of orthopedic procedures (i.e. total hip arthroplasty, total knee arthroplasty). The goal of CAN is to increase surgical accuracy and reduce the chance of malposition of an implant.

What is computer assisted knee replacement? ›

Computer-assisted or robotic assisted knee replacement is an alternative to the typical knee replacement surgery. In computer-assisted knee replacement surgery, the surgeon uses robotic arm technology to help them perform the total knee replacement surgery.

What are the disadvantages of robotic knee surgery? ›

Complications of the robotic system were pin-hole fracture, pin-related infection, iatrogenic soft tissue and bony injury, and excessive blood loss. While, downsides were longer operative duration, higher intraoperative cost, learning curve and aborting a robotic TKA due to different reasons.

Is there less pain with robotic knee replacement? ›

Less Pain and a Faster Recovery After Surgery

This means there's less pain and a faster recovery. And, because your surgeon can provide a better joint alignment using Mako technology, it can mean you walk more naturally, sooner.

Who is a good candidate for robotic knee replacement? ›

Patients who have osteoarthritis may be good candidates for robotic knee surgery if their condition hasn't progressed too extensively. If the swelling, stiffness, and pain around your knee have become so bad that you can no longer take part in regular exercise and activities, be sure to tell your doctor that.

Does Medicare cover computer assisted navigation? ›

Medicare does not have a National Coverage Determination (NCD) for computer-assisted surgical navigation for orthopedic procedures.

Is 20985 covered by Medicare? ›

Documentation/operative report must identify and describe the procedures performed. Codes 20985, 0054T, or 0055T are not covered services and are not separately reimbursable.

What is the CPT code for computer assisted navigation? ›

Effective from January 1, 2011 the appropriate CPT codes for billing image guided FESS are +61781 – stereotactic computer assisted (navigational) procedure; cranial, intradural (list separately in addition to code for primary procedure) or +61782 – cranial, extradural (list separately in addition to code for primary ...

What is the success rate of robotic knee replacement? ›

However, patient satisfaction remains an issue, with satisfaction rates ranging between 82% and 89%.

How much does robotic knee surgery cost? ›

The robot is imported and costs around Rs 5 crore, said an official of the hospital. The cost of a traditional knee-replacement surgery at the hospital is around Rs 2 lakh and a robot-assisted surgery costs around Rs 2.3 lakh, he added.

What is arthroplasty in surgery? ›

What is arthroplasty? Arthroplasty is a surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used.

What is the newest knee replacement surgery? ›

Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested reliable knee replacement implants through a shorter incision using surgical approach that avoids trauma to the quadriceps muscle (see figure 1) which is the most important muscle ...

What is the recovery time for robotic knee replacement? ›

Because it's minimally invasive, patients with robotic assisted total knee replacement can often go home after surgery, skipping having to stay in the hospital. Once home, it may take up to six weeks to fully recover. During this time, you'll participate in physical therapy exercises and techniques.

What is the best knee surgery to have? ›

A TKR is now among the safest and most effective of all standard orthopedic surgeries. During a TKR, a surgeon removes the surface of your bones that have been damaged by osteoarthritis or other causes and replaces the knee with an artificial implant that is selected to fit your anatomy.

How big is the incision for robotic knee replacement? ›

Minimally invasive surgery for knee replacement involves the use of smaller incisions which are only 4 to 6 inches in length as compared to the 10-12 inch long incision used in the traditional procedure. Robotic-assisted knee replacement surgery is an alternative to the conventional knee replacement procedure.

How many incisions do you need for a robotic knee replacement? ›

Surgeons perform robotic surgery using minimally invasive means. Instead of a large incision, the surgeon uses 2 or 3 buttonhole incisions to insert the tools. That means less blood and faster surgery.

How do I prepare for a robotic knee replacement? ›

How should I prepare for a Robotic Knee Replacement?
  1. Follow your surgeon's instructions. The best way to prepare for a robotic knee replacement is to follow your surgeon's advice. ...
  2. Drug and supplement requirements. ...
  3. Stop smoking. ...
  4. Focus on your physical fitness. ...
  5. Prepare the home and arrange assistance.
May 27, 2022

What can you not do after knee replacement? ›

After your surgery, avoid stools, sofas, soft chairs, rocking chairs, and chairs that are too low. When getting up from a chair, slide toward the edge of the chair, and use the arms of the chair, your walker, or crutches for support to get up.

Does Medicare pay for robotic knee replacement surgery? ›

Medicare covers medically necessary services, robotic surgery is no exception. Since the FDA approves robotics, coverage may be available for some robotic surgery procedures.

Is robotic surgery better? ›

Because it is less invasive and more precise, robotic surgery offers several patient benefits when compared to traditional open surgery. These include: Smaller incisions. Lower risk of infection.

Does Aetna cover robotic surgery? ›

Robotic Surgery-

As such, it is considered incidental to the professional services and is included in the payment for the surgical procedure.

What is the primary procedure code for 61783? ›

Possible primary procedure codes for use with 61783 include 22600, 22610 and 22612.

Is CPT code S2900 covered by Medicare? ›

S2900 is not a code that is processed by Medicare.

What procedures are not covered by Medicare? ›

Some of the items and services Medicare doesn't cover include:
  • Long-Term Care. ...
  • Most dental care.
  • Eye exams related to prescribing glasses.
  • Dentures.
  • Cosmetic surgery.
  • Acupuncture.
  • Hearing aids and exams for fitting them.
  • Routine foot care.

What CPT codes are not accepted by Medicare? ›

Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services.

What is non-covered charges in medical billing? ›

Definition of Non-covered Charges

In medical billing, the term non-covered charges refer to the billed amount/charges that are not paid by Medicare or any other insurance company for certain medical services depending on various conditions. Filing claims for non-covered charges are likely to result in denial of claims.

Does CPT 69990 need a modifier? ›

CPT has designated codes 64727 and 69990 as add-on codes. These codes must be reported (without modifier 51 appended) in addition to the code for the primary procedure performed.

What is the primary code for S2900? ›

The Health Care Common Procedure Coding System (HCPCS) code S2900 (Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)) describes a computer-aided tool used in performing a specific surgical procedure.

Is O arm computer Assisted? ›

The StealthStation® Surgical Navigation System and The O-Arm® Surgical Imaging System Dr. Braxton utilizes are the technologies of choice for computer assisted surgery and neuronavigation. The StealthStation® Surgical Navigation System is much like a GPS system.

How much does robotic knee surgery cost? ›

The robot is imported and costs around Rs 5 crore, said an official of the hospital. The cost of a traditional knee-replacement surgery at the hospital is around Rs 2 lakh and a robot-assisted surgery costs around Rs 2.3 lakh, he added.

How painful is a total knee replacement? ›

Will I have severe pain after knee replacement surgery? Pain is to be expected after the initial knee replacement, but it should not be severe. The first few days after surgery should include the highest level of pain, but your doctor will send you home with pain medication adequate for your pain level.

Can you kneel down with a knee replacement? ›

According to the American Academy of Orthopedic Surgeons, kneeling is not harmful to your knee after a total knee replacement, although it may be uncomfortable.

How long is recovery from minimally invasive knee replacement? ›

Patients with desk type work can return two to six weeks after the procedure, while patients with more physically demanding jobs can return between six to twelve weeks after surgery. The implants used with this procedure are the same ones used with traditional knee replacements.

What is the recovery time for robotic knee replacement? ›

Because it's minimally invasive, patients with robotic assisted total knee replacement can often go home after surgery, skipping having to stay in the hospital. Once home, it may take up to six weeks to fully recover. During this time, you'll participate in physical therapy exercises and techniques.

What is the success rate of robotic knee replacement? ›

However, patient satisfaction remains an issue, with satisfaction rates ranging between 82% and 89%.

What is the newest procedure for knee replacement? ›

Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested reliable knee replacement implants through a shorter incision using surgical approach that avoids trauma to the quadriceps muscle (see figure 1) which is the most important muscle ...

What you Cannot do after knee replacement? ›

Activities you Cannot do After Full Recovery

In general, avoid sports that require jerking, twisting, pulling, or running. You should be able to do lower-impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.

What is the fastest way to recover from a knee replacement? ›

The Fastest Way To Recover From Knee Replacement Surgery
  1. Move Little and Often, Every Hour. ...
  2. Use Equipment Provided To You. ...
  3. Follow Your Exercise Plan. ...
  4. Avoid Kneeling, Or Putting Pressure Against Your Knee. ...
  5. Get Great Sleep and Rest. ...
  6. Avoid High Impact Activities Or Activities With A High Risk Of Falling, Or Twisting Your Knee.
Jan 27, 2022

Can you climb stairs after knee replacement? ›

Answer: Immediately after surgery you will learn to climb stairs safely using crutches. As recovery continues and you work on flexion and extension of the new knee, you will be able to climb without crutches. With the help of physical therapy and building up the quadriceps muscles, stair climbing will be a breeze.

Can I ever cross my legs after knee replacement? ›

After your knee replacement surgery, it is important to remember that you should not cross your legs at any time.

Is it OK to sleep on your side after total knee replacement? ›

Sleeping on the side can be painful because the leg is not straight enough. However, gradually, you can start sleeping on your side as the knee heals. But avoid sleeping on the operative side at all costs, as it puts a lot of pressure on the surgery site.

How much weight can you lift after total knee replacement? ›

Also try and avoid any heavy lifting (more than 40 lb) or weight lifting as this could slow your total knee replacement recovery.

What is the best age for knee replacement surgery? ›

In summary, TKA performed between the ages of 70 and 80 years has the best outcome. With respect to mortality, it would be better to perform TKA when the patients are younger. Therefore, the authors of these studies believe that from 70 to 80 years of age is the optimal range for undergoing TKA.

What is the most commonly reported problem after knee replacement surgery? ›

Knee Stiffness

One of the most common problems people experience after knee replacement is a stiff knee joint. Often these symptoms can cause difficulty with normal activities including going down stairs, sitting in a chair, or getting out of a car.

Do you need a knee replacement if you are bone-on-bone? ›

Bone-on-Bone Arthritis

Before considering knee replacement, the patient should have X-rays that show bone touching bone somewhere in the knee. Patients who have thinning of the cartilage but not bone touching bone should not undergo knee replacement surgery, except in rare circumstances.

Videos

1. Computer Assisted Navigation for Knee Replacement in San Antonio, TX
(TSAOG Orthopaedics & Spine)
2. Total Knee Replacement through Computer Navigation explained by Dr Deepak Thakur
(Nayati Healthcare)
3. Dr. Eric Tannenbaum - Knee Replacement Surgery using Computer Assisted Navigation
(Eric Tannenbaum, M.D.)
4. Navigation assisted primary total knee arthroplasty
(­배지훈[ 교수 / 의학과 ])
5. Dr. Jeff Hodrick - Computer Navigated Total Knee Arthroplasty Interview
(Jeferry Hodrick)
6. Computer Navigated Knee Replacement - Marc Conell, M.D.
(SibleyVideos)

Top Articles

You might also like

Latest Posts

Article information

Author: Fr. Dewey Fisher

Last Updated: 12/17/2022

Views: 5343

Rating: 4.1 / 5 (42 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Fr. Dewey Fisher

Birthday: 1993-03-26

Address: 917 Hyun Views, Rogahnmouth, KY 91013-8827

Phone: +5938540192553

Job: Administration Developer

Hobby: Embroidery, Horseback riding, Juggling, Urban exploration, Skiing, Cycling, Handball

Introduction: My name is Fr. Dewey Fisher, I am a powerful, open, faithful, combative, spotless, faithful, fair person who loves writing and wants to share my knowledge and understanding with you.