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Introduction
On the 21
st
of January 1997, the first ever
navigated total knee replacement (TKR) was
performed in Grenoble, France. After ethical
approval, five patients underwent CT-free
navigation surgery and the preliminary results
were published in CORR in 1998 [1, 2]. Since
then, several companies have developed,
implemented and improved robotics assistive
and computer-assisted systems to help
orthopaedic surgeons to navigate knee
arthroplasties. With the advance of medical
imaging technology, mechatronics, and haptic
technology, several surgical and scientist teams
have conceived instruments that can help
surgeons to perform more accurate and more
precise orthopaedic surgical procedures. Total
knee arthroplasty (TKA or TKR) is described
in this article as it is the joint most often
navigated procedure but many other surgical
procedures are performed using Computer
Assisted Surgery (CAS) such as Total Hip
Replacement (THR), High Tibia Osteotomy
(HTO), Distal Femoral Osteotomy (DFO),
Anterior Cruciate Ligament Reconstruction
(ACLR), or even Spine and this list is not
exhaustive [3, 4, 5, 6].
In orthopaedics, the pioneers were undoubtedly
spine surgeons associated with neurosurgeons
who were quickly involved in the concept of
image-guided surgery, mainly to secure pedicle
screw placements and complex sacro-iliac
fixations [7, 8]. At the same time, innovators in
California brought active robotic instrumen
tations in theatre in order to facilitate the intra-
femoral medullary canal preparation to fit
perfectly any femoral stem [9]. The computer’s
power, which according to Moore’s law almost
doubled every eighteen months will be as
powerful as a human brain by 2020 [10] and
has contributed complex and sophisticated tool
designs available to the orthopaedic surgeons
tool-box [11].
In spite of increasing advances of technology,
CT-free or image free also named non-image
based navigation still dominates other types of
systems in CAS total knee arthroplasty (TKA)
[12, 13]. Several reasons are allotted to the
success of CT-free navigation such as its
reliability equating CT-based navigation’s
reliability, its user friendliness, no need for pre-
operative data acquisitions (i.e. CT or MRI
scans) [14, 15]. However, even though this
technology has been through several cycles of
trials and errors, as well as substantial
enhancements such stream lined software or
ergonomics simplification, this technology is
still not mainstream yet [16]. The National
Registry of countries, such as Australia (>8%),
England (<3%) or Norway (<5%) are all
showing limited numbers of computer-assisted
Knee Navigation in Knee
Arthroplasty in 2014
15 years of experience
F. Picard, F. Leitner, A. Gregori, D. Saragaglia