Specifics of rotational planning and intraoperative alignment of the femoral component in the knee implant with navigation devices (systematic review)

Introduction The optimal rotational alignment of the femoral component in a knee implant with navigation devices is important for total knee arthroplasty. Measured resection and gap technique are available intraoperative methods to determine the rotation of femur with navigation devices, but each of these methods has its advantages and disadvantages. These aspects have contributed to the development and clinical validation of navigation tools for large joint arthroplasty.

The objective of this study was to evaluate the efficacy of determining the rotational alignment of the femoral component in a knee implant with mechanical and robotic navigation devices as a basis for processing intraoperative decision making by surgeons.

Material and methods The planning, execution and reporting of this systematic review were conducted in accordance with the established Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Initially we identified 366 studies that corresponded to the main focus of this research, and 158 studies were selected for analysis after the duplicates had been excluded. Ultimately, only 11 studies fully met the selection criteria. The evaluation included the article data, the type of mechanical or robotic navigation device, the number of cases, the complication rate, and the specifics of the preoperative, intraoperative, and postoperative methods used for determining the rotation of the femoral component in a knee implant in the cohorts reviewed. A total of 1,198 total knee arthroplasties reported in those studies were analyzed.

Results and discussion It should be noted that in most of the scientific papers on the postoperative complications of surgeries that involved various navigation devices, the information about them was incomplete or the patients with complications were excluded from the study. In general, the incidence of complications averaged 2 %.

Conclusions When the navigation devices are used, the preoperative planning of the femoral component alignment frequently remains unperformed, and techniques and reference points used in surgeries are the same as in the traditional technique. The postoperative monitoring of rotational alignment of the knee implant is performed exclusively when complications are detected.

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