Deviations between intra-operative navigation data and post-operative weight-bearing X-rays

Several studies have shown that computer-navigated TKA reduces the rate of outliers. Thirty-one consecutive patients were operated on by the same surgeon using a computer assisted navigation system. Data collected by the system included the final mechanical axis of the extremity (HKA angle) and the coronal angle of the tibial and femoral implants. These same values were measured using CAD software on full weight-bearing long X-rays taken 6 weeks post-surgery. Deviations were observed when X-ray measurements were compared to intra-operative data collected from the navigation system. A statistically significant difference was found in the tibial cut (1.29° ± 1.35°; p < 0.0001) and in the HKA (1.59° ± 2.36°; p 0.0007). Outliers of more than 3° were observed in the coronal plane of the tibial implant in 9.6 of patients, in the coronal plane of the femoral implant in 6.4 of patients, and in the HKA angle of 29 of patients. Our results indicate that the use of navigation alone is insufficient to prevent outliers beyond an acceptable range of 3°.