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Navigation for total knee arthroplasty (TKA) is
currently used all over the world. We implanted
for the first time a computer-assisted TKA on
January 21, 1997. Since March 1999 we have
been using navigation for all TKA we perform.
We published a prospective randomized study
in 2001 [1] and currently, in my department,
navigation is used not only for TKA, but also
for osteotomies around the knee, UniKA and
UniKA revision. We use a non-image based
device (Orthopilot
TM
, B-Braun-Aesculap,
Tuttlingen, Germany) and the operative
procedure was well described in several
publications [1, 2, 3].
Today, despite the fact that this technology
improves the accuracy of the implantation of
the prosthesis [4, 5, 6, 7, 8, 9] and allows to
reach more easily the pre operative goal,
navigation has not had the development one
could hope. Users can be estimated at 30% in
Germany, 5 to 10% in France and 5% in Great
Britain. Some surgeons are very enthusiastic,
others are indifferent or against [10]. However,
enthusiasm for this innovative technology is
still present as more than 200 articles have been
published over the past 3.5 years.
History of TKA
navigation
Computer-assisted surgery began with
stereotactic neurosurgery [11] towards the end
of the 1980s. This new technique had for aim to
improve the precision of operations, reduce
surgical invasivness and improve the
traceability of interventions.
The history of computer-assisted implantation
of total knee prostheses dates back to 1993
when we set up a work group including
2 surgeons (D. Saragaglia and F. Picard),
1
medical
doctor/computer
scientist
(P. Cinquin), 2 computer scientists (S. Lavallée
and F. Leitner) and an industry partner, which
was at the time I.C.P France (bought-over by
Aesculap-AG, Tuttlingen, Germany, in 1994).
In our first meeting the senior surgeon (DS),
drew up the specifications defining computer
assistance for TKA. A pre-operative scan was
not needed to guide surgical navigation for
several reasons: this was firstly because, at the
time, this examination was not part of the pre-
operative check-up required for a knee
prosthesis, secondly, we felt that an examination
Place of navigation in 2014:
why I resolutely navigate
all my TKA?
D. Saragaglia, A. Krayan