Orthopedics This Week - 2018 | July 17, 2018 | Page 15

ORTHOPEDICS THIS WEEK
VOLUME 14, ISSUE 23 | JULY 17, 2018
Dr. Mullaji: Houston, we have a prob-
lem. Some surgeons have developed
the ostrich syndrome and are ignoring
facts. The first one is that alignment is
superior with navigation—I think Rob-
ert has accepted that.
But he quoted a meta-analysis from
2007.
More recent papers show that the risk
of malalignment is much higher and all
favor navigation. No question about it.
If you can restore the alignment within
3 degrees of what you want, the scores
are much higher. The International
Knee Score, the SF-12, mental and
physical scores are much better, if you
can get them aligned. And this is par-
ticularly valuable in the obese patients,
in those where there is an implant and
an extraarticular deformity.
Fact #2: you can do much better bal-
ancing of soft tissues with navigation.
Consider a severely unstable, malaligned
patient. You can assess his/her deformi-
ty very accurately with navigation, do a
tibia cut and then check your alignment
and balance in extension. Do a soft tis-
sue release as required and then again
check that you’ve obtained balance and
alignment.
Then you can balance your flexion
gap exactly to your extension gap and
then proceed with the cuts after you
have done the planning to get equal
flexion and extension gaps. You can
check your alignment and stability,
not only in extension, but also right
through the range of motion to full
flexion.
Fact # 3: Functional results are supe-
rior. Dr. Trousdale didn’t look at all of
the published papers. Gothesen, et al.
(Bone Joint J 2014) reported at 3 months
and 1 year that the KOOS scores are sig-
nificantly better with navigation.
15
At 5 years, a prospective study (Hof-
fart, et al., JBJS Br 2012), compares the
pain scores, the knee scores, the func-
tion scores, as well as the Knee Society
scores. And all these are superior with
navigation.
Fact # 4: Complications are actually
fewer and the most dreaded one is of
emboli, and a recent paper in JBJS-Am
(Malhotra, et al., 2015) is a prospec-
tive, randomized study which looked
at the number of emboli and calculated
the embolic scores. With navigation the
scores are much lower when compared
to conventional surgery.
Fact # 5: Revisions are reduced. A
paper based on the Australian Registry
(de Steiger, et al., JBJS-Am 2015) shows
that CAS reduces the revision rate
for patients under the age of 65 years
(6.3% vs 7.8% with conventional). This
is significant because patients under the
age of 65 years are most likely to have
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