Total Knee Arthroplasty in Patients With Extra-Articular Deformity: Restoration of Mechanical Alignment Using Accelerometer-Based Navigation System

Background: Total knee arthroplasty (TKA) in patients with post-traumatic extra-articular deformity (EAD) is difficult to manage using conventional instrumentation techniques. In this study, we evaluate whether accelerometer navigation system can be a valuable option to make accurate bone resections and restore the neutral mechanical axis in complex TKA patients with EAD. Methods: From May 2015 to June 2017, 18 consecutive TKA were performed in 18 patients with knee osteoarthritis with associated EAD. An accelerometer-based navigation system was used to guide tibial and femoral resection in the coronal and sagittal plane. Postoperative lower limb alignment in coronal plane and component position in coronal and sagittal plane was measured through full-leg weightbearing X-ray. Clinical score were recorded using the Knee Society Score at the final follow-up. Results: The mean hip-knee-ankle angle was 0.9 degrees +/- 1.4 degrees varus alignment. The coronal alignment of the femoral component was 89.2 degrees +/- 1.9 degrees, and the coronal alignment of the tibial component was 89.4 degrees +/- 2.1 degrees. The sagittal alignment of the femoral component was 93.2 degrees +/- 1.9 degrees, and the sagittal alignment of the tibial component was 84.4 degrees +/- 3.1 degrees. At the final follow-up, the Knee Society Score was 89 points (range, 82-100), and the functional score was 86.7 points (range, 60-100). No intraoperative and postoperative surgical complications were reported using this technology. Conclusion: Accelerometer-based navigation is accurate in achieving neutral mechanical alignment and optimal implant position after TKA in patients with EAD. This system should be considered a valuable option to the more complex technique of computer navigation or robotic surgery. (c) 2019 Elsevier Inc. All rights reserved.