Comparative Analysis of Diaphyseal Versus Metaphyseal Tracker Placement in Imageless Navigation Systems for Total Knee Arthroplasty

Abstract

This work was designed to compare the intraoperative parameters and clinical and radiologic outcomes of total knee arthroplasty (TKA) during a minimum follow-up period of 2 years and to discuss the pros and cons of two different tracker placement (diaphyseal and metaphyseal) navigation systems. The null hypothesis was that there would be no clinical or radiologic difference between the two different systems. Primary TKA was performed in a total of 100 knees using the two different image-free navigation systems (group 1: diaphyseal tracker placement and group 2: metaphyseal tracker placement) with the strict gap balancing technique. Symptom severity was assessed at preoperative and at 3, 6, 12, and 24 months after surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Possible adverse issues (major and minor) associated with TKA procedure were observed. Careful assessments were also made of the screw insertion site for infection, stress fractures, and any other related adverse effects. The follow-up periods for groups 1 and 2 were 38 ± 8 months and 38 ± 7 months, respectively. The minimum follow-up period was 24 months. The mechanical alignment improved to 0.1 (valgus) ± 2.2 (group 1) and 0.2 (valgus) ± 2.1 (group 2). There were no radiologic differences between the groups (p > 0.05). In both groups, the KSS and WOMAC improved from before surgery to 24 months after surgery (p < 0.0001). However, the total operation time was 50 ± 5 minutes for group 1, compared to 65 ± 13 minutes for group 2 (p < 0.0001). The metaphyseal tracker navigation system resulted in increased operation time.