Computer navigation and conventional technique in total knee replacement

Description:
Hybrid total knee replacements are prosthesis with cemented tibia and cementless femur. Computer assisted surgery is the use of three dimensional modeling and data registration to improve outcome of surgery.
Tranexamic acid is a antifibrinolytic agent which decreases bleeding.

Background:
Knee joint replacement with total condylar knee prosthesis is a highly successful operation with survival rates greater than 90% at 10 years.
The fixation of primary total knee replacements (TKR) have been extensively discussed, but no general agreement has been reached. Cemented prostheses are regarded as the gold standard for knee prosthesis surgery. Cementless fixation and hybrid fixation, however, remains of interest and is widely used.
Improvement of positioning and alignment by the use of computer-assisted surgery (CAS) might improve longevity and function in TKR, but there is little evidence. Many surgeons are using CAS to day.
The use of Tranexamic acid to reduce bleeding has increased markedly the last few years. There is no question about its efficiency in reducing blood loss and the use of blood transfusion, but there is little data about possible thromboembolic complication.

Methods:
Register studies
Prospective randomized clinical studies
Radiosterometry
Conventional X-ray
CT-Perth
Clinical follow up of patients

Purpose:
Main purpose is to evaluate method used. How the method influence survival of the prosthesis, function of the patient and possible complication.

Aim:
-Study the hybrid and compare it to the conventional cemented total knee replacement.
-Study the CAS and compare it to the conventional knee replacement using RSA, CT-Perth and standard X-rays.
-Study Tranexamic acid and its influence on blood coagulation in patients operated with TKR and compare it with patients operated without Tranexamic acid.
-By documentation of different methods our aim of research is to reduce revision surgery and minimize risk of complication.

Planned studies:
1. Hybrid total knee arthroplasty. A report from the Norwegian Arthroplasty Register 1999-2009.
2. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomized prospective trial with Radioisometric analysis.
3. Function and quality of life in correlation with CT results after 3, 12 and 24 months after total knee replacement.
4. The correlation between alignment of bone cuts and prostheses components alignment in cemented total knee replacement.
5. The influence of Tranexamic acid in total knee arthroplasty.

Supervisors:
Ove Furnes, MD, PhD, Professor, Orthopedic Surgeon
Stephan M. Röhrl, MD, PhD, Orthopedic Surgeon
Arild Aamod, MD, PhD, Professor, Orthopedic Surgeon
Lars Nordsletten, MD, PhD, Professor, Orthopaedic Surgeon

Publications 2011
Gøthesen O, Espenhaug B, Havelin L, Petursson G, Furnes O.
Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005-2008.
Acta Orthop. 2011 Jun;82(3):293-300. Epub 2011 Apr19.
PubMed 21504309

 
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