Does Computer Navigation Improve the Results of MIS Technique in Total Knee Arthroplasty?


The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive surgery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone structures, which may lead to alterations in the correct placement of the prosthetic components. Navigation-assisted surgery may help avoid such mistakes, and thus navigation coupled with the MIS technique may be an alternative for the future. This is a prospective randomized study of 50 patients who received a total knee arthroplasty. In 25 cases the MIS technique was used, whereas in the other 25 navigation was also employed. Mean age of the patients was 71.63 years, and the mean body mass index was 31.19. Results were assessed based on the definitive radiographic position of the femoral, tibial, and limb axis prosthetic components, as well as according to the Visual Analogue Scale (VAS), the Knee Society Score (KSS), Western Ontarioand McMaster Universities Arthritis Index (WOMAC), Short Form version 12 (SF-12) questionnaires, and the up-and-go test. Differences were found between both groups for duration of the procedure (p = 0.0005). No differences were found in the need for analgesics, amount of drained blood, or mean stay time. There were differences regarding the best radiographic position of the tibial component in the navigation group, but not in the final mechanical axis of the limb, even though out-of-range cases were more abundant in the standard-MIS group. At one year after surgery, clinical, functional and quality of life outcomes were similar in both groups. The combined use of surgical navigation and the MIS technique does not yield advantages in terms of limb alignment nor clinical results at one year after surgery.

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A. Noriega, D. Vaquero, J. Lombardia, J. Figaredo and M. Garcia, "Does Computer Navigation Improve the Results of MIS Technique in Total Knee Arthroplasty?," International Journal of Clinical Medicine, Vol. 4 No. 6A, 2013, pp. 5-10. doi: 10.4236/ijcm.2013.46A002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. S. Laskin, B. Beksac, A. Phongjunakorn, K. Pittors, J. Davis, J. C. Shim, H. Pavlov and M. Petersen, “Minimally Invasive Total Knee Replacement through a Mini-Midvastus Incision: An Outcome Study,” Clinical Orthopaedics and Related Research, Vol. 428, 2004, pp. 74-81. doi:10.1097/01.blo.0000148582.86102.47
[2] S. B. Haas, S. Cook and B. Beksac, “Minimally Invasive Total Knee Replacement through a Mini Midvastus Approach: A Comparative Study,” Clinical Orthopaedics and Related Research, Vol. 428, No. 11, 2004, pp. 68-73. doi:10.1097/
[3] J. B. Reid 3rd, D. Guttmann, M. Ayala and J. H. Lubowitz, “Minimally Invasive Surgery-Total Knee Arthroplasty,” Arthroscopy, Vol. 20, No. 8, 2004, pp. 884-889. doi:10.1016/j.arthro.2004.07.021
[4] E. M. Goble and D. F. Justin, “Minimally Invasive Total Knee Replacement: Principles and Technique,” Orthopaedics Clinical North American, Vol. 35, No. 2, 2004, pp. 235-245. doi:10.1016/S0030-5898(03)00113-5
[5] A. J. Tria, “Minimally Invasive Total Knee Arthroplasty: The Importance of Instrumentation,” Orthopaedics Clinical North American, Vol. 35, No. 2, 2004, pp. 227-234. doi:10.1016/S0030-5898(03)00118-4
[6] P. M. Bonutti, M. G. Zywiel, S. D. Ulrich, M. S. McGrath and M. A. Mont, “Minimally Invasive Total Knee Arthroplasty: Pitfalls and Complications,” American Journal of Orthopaedics, Vol. 39, No. 10, 2010, pp. 480-484.
[7] R. S. Laskin, “Minimally Invasive Total Knee Replacement Using a Mini-Mid Vastus Incision Technique and Results,” Surgical Technologie Internationale, No. 13, 2004, pp. 231-238.
[8] D. Hernández-Vaquero, A. Noriega-Fernández and A. Suárez-Vázquez, “Total Knee Arthroplasties Performed with a Mini-Incision or a Standard Incisión. Similar Results at Six Months Follow up,” BMC Musculoskeletal Disorders, Vol. 11, 2010, p. 27. doi:10.1186/1471-2474-11-27
[9] A. Tanavalee, S. Thiengwittayaporn and P. Itiravivong, “Results of the 136 Consecutive Minimally Invasive Total Knee Arthroplasties,” Journal Medical Association Thai, 2005, Vol. 88, Suppl. 4, pp. S74-S78.
[10] Y. Hoo Kim, K. S. Sohn and J. D. Kim, “Short-Term Results of Primary Total Knee Arthroplasties Performed with a Mini-Incision or a Standard Incision,” Journal of Arthroplasty, Vol. 21, No. 5, 2006, pp. 712-718. doi:10.1016/j.arth.2005.09.001
[11] A. Ensini, F. Catani, A. Leardini, M. Romagnoli and S. Gianinni, “Alignments and Clinical Results in Conventional and Navigated Total Knee Arthroplasty,” Clinical Orthopaedics and Related Research, Vol. 457, No. 4, 2007, pp. 156-162.
[12] G. Matziolis, D. Krocker, U. Weiss, S. Tohzt and C. Perka, “A Prospective, Randomized Study of Computer Assisted and Conventional Total Knee Arthroplasty. Three-Dimensional Evaluation of Implant Alignment and Rotation,” Journal of Bone and Joint Surgery, Vol. 89, No. 2, 2007, pp. 236-243. doi:10.2106/JBJS.F.00386
[13] D. Zorman, P. Etuin, H. Jennart, D. Scipioni and S. Devos, “Computer Assisted Total Knee Arthroplasty: Comparative Results in a Preliminary Series of 72 Cases,” Acta Orthopaedica Belgica, Vol. 71, No. 6, 2005, pp. 696-702.
[14] S. K. Chauhan, R. G. Scott, W. Breidahl and R. J. Beaver, “Computer Assisted Knee Arthroplasty versus a Conventional Jig-Based Technique. A Randomized Prospective Trial,” Journal of Bone and Joint Surgery, Vol. 86, No. 3, 2004, pp. 372-377. doi:10.1302/0301-620X.86B3.14643
[15] M. Sparmann, B. Wolke, H. Czupalla, D. Banzer and A. Zink, “Positioning of Total Knee Arthroplasty with and without Navigation Support. A Prospective, Randomized Study,” Journal of Bone and Joint Surgery, Vol. 85, No. 6, 2003, pp. 830-835.
[16] J. B. Mason, T. K. Fehring and R. Estok, D. Banel and K. Fahrbach, “Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery,” Journal of Arthroplasty, Vol. 22, No. 8, 2007, pp. 1097-1106. doi:10.1016/j.arth.2007.08.001
[17] Y. S. Brin, V. S. Nikolaou, L. Joseph, D. J. Zukor and J. Antoniou, “Imageless Computer Assisted versus Conventional total Knee Replacement. A Bayesian Meta-Analysis of 23 Comparative Studies,” International Orthopaedics, Vol. 14, No. 3, 2010, pp. 31-39.
[18] P. M. Bonutti, D. A. Dethmers, M. S. McGrath, S. D. Ulrich and M. A. Mont, “Navigation Did Not Improve the Precisión of Minimally Invasive Knee Arthroplasty,” Clinical Orthopaedics Related Research, Vol. 466, No. 11, 2008, pp. 2730-2735. doi:10.1007/s11999-008-0359-4
[19] D. Hernandez-Vaquero, A. Suarez Vazquez, M. A. Sandoval-Garcia and A. Noriega-Fernandez, “Computer Assistance Increases Precision of Component Placement in total Knee Arthroplasty with Articular Deformity,” Clinical Orthopaedic Related Research, Vol. 468, No. 5, 2010, pp. 1237-1241. doi:10.1007/s11999-009-1175-1

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