Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique.

Accurate reconstruction of leg alignment is one important factor for long-term survival in total knee arthroplasty (TKA). Recent developments in computer-assisted surgery focused on systems improving TKA. The aim of the study is to compare the results of computer-assisted revision TKA with the conventional technique. We hypothesize that a significantly better leg alignment and component orientation is achieved when using a navigation system for revision TKA. In a prospective study, two groups of 25 revision TKAs each were operated on using either a CT-free navigation system or the classical surgeon-controlled technique. The postoperative leg alignment was analysed on long-leg coronal and lateral X-rays. The mechanical limb axis was significantly better in the navigation-based group. Twenty-three patients (92%) in the computer-assisted group had a postoperative leg axis between 3 degrees varus/valgus deviation, while 19 patients (76%) in the conventional group had a comparable result (p<0.05). Further, significant differences were seen for the coronal orientation of the femoral component. Computer-assisted revision TKA leads to a superior restoration of leg alignment compared with the conventional technique. Particularly the real-time presentation of the actual leg axis and the flexion and extension gaps is useful in revision TKA. Potential benefits in long-term outcome and functional improvement require additional investigation.