ORTHOPEDICS THIS WEEK VOLUME 14 , ISSUE 23 | JULY 17 , 2018 14
But that ’ s not really been proven .
Mark Pagnano at our place , I think , was one of the first people to question the role of the mechanical axis as far as durability and function with total knee replacements . If you look at a series of Mayo Clinic patients at 15-year follow-up , 275 patients , 399 knees , the mechanical axis was measured in 5 zones ( Parratte , et al ., JBJS Am 2010 ). Most of the patients ended up in zone 3 , that ’ s the middle . But there were some outliers — a little bit of varus ; a little bit of valgus .
And the authors also looked at the overall durability of the knee . Revision for any reason was no different at 15 years whether the knees were in the well-aligned group , or if they were in the outlier group . They looked at survival free revision for aseptic loosening or wear / osteolysis by alignment . Again , no difference .
This study doesn ’ t mean that alignment isn ’ t important . All of us would agree , I think , that alignment is one of the factors that is important in total knee surgery . What this study does tell us is that there are other factors that are more important for 15-year durability . Alignment is important , but if you have a little bit of varus in your knee I ’ m not sure the durability is going to be badly affected if other factors aren ’ t taken into consideration .
CAS is more complex . There are tracking devices . You ’ ve got a camera in the operating room . The work is more complex for your assistants .
I do think we should want to harness the power of the computer for our knee replacements , if accuracy , efficiency , decreased cost ( potentially ) and fewer complications can be achieved .
I think , however , it may be better to use the computer outside the operating room . There are a lot of techniques that are coming into play with advances in 3D reconstruction . I think in the future it ’ s going to be patient-specific solutions , not generic average solutions — putting the mechanical axis down the middle — that ’ s going to really shift the bar for our patients .
I argue to you that , today , routine use of a computer in the operating room remains a cumbersome , relatively time consuming , relatively expensive tool , with very limited proven clinical benefit for your patients .
As a research tool it will help us , I think in the future , to find the right targets and once we find that for the individual patient , I think then the computer is going to help us with that individual patient — put that alignment exactly where that patient needs to be .
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