{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T21:14:28Z","timestamp":1781903668637,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,12,22]],"date-time":"2007-12-22T00:00:00Z","timestamp":1198281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2008,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Accuracy of implant positioning and reconstruction of the mechanical leg axis are major requirements for achieving good long\u2010term results in total knee arthroplasty (TKA). The purpose of the present study was to determine whether image\u2010free computer navigation technology has the potential to improve the accuracy of component alignment in TKA cohorts of experienced surgeons immediately and constantly. One hundred patients with primary arthritis of the knee underwent the unilateral total knee arthroplasty. The cohort of 50 TKAs implanted with conventional instrumentation was directly followed by the cohort of the very first 50 computer\u2010assisted TKAs. All surgeries were performed by two senior surgeons. All patients received the Zimmer NexGen\u2122 total knee prosthesis (Zimmer Inc., Warsaw, IN, USA). There was no variability regarding surgeons or surgical technique, except for the use of the navigation system (StealthStation<jats:sup>\u00ae<\/jats:sup> Treon plus<jats:sup>\u00ae<\/jats:sup>, Medtronic Inc., Minnesota, MI, USA). Accuracy of implant positioning was measured on postoperative long\u2010leg standing radiographs and standard lateral X\u2010rays with regard to the valgus angle and the coronal and sagittal component angles. In addition, preoperative deformities of the mechanical leg axis, tourniquet time, age, and gender were correlated. Statistical analyses were performed using the SPSS 15.0 (SPSS Inc., Chicago, IL, USA) software package. Independent <jats:italic>t<\/jats:italic>\u2010tests were used, with significance set at <jats:italic>P<\/jats:italic> &lt; 0.05 (two\u2010tailed) to compare differences in mean angular values and frontal mechanical alignment between the two cohorts. To compute the rate of optimally implanted prostheses between the two groups we used the \u03c7<jats:sup>2<\/jats:sup> test. The average postoperative radiological frontal mechanical alignment was 1.88\u00b0 of varus (range 6.1\u00b0 of valgus\u201310.1\u00b0 of varus; SD 3.68\u00b0) in the conventional cohort and 0.28\u00b0 of varus (range 3.7\u00b0\u20136.0\u00b0 of varus; SD 1.97\u00b0) in the navigated cohort. Including all criteria for optimal implant alignment, 16 cases (32%) in the conventional cohort and 31 cases (62%) in the navigated cohort have been implanted optimally. The average difference in tourniquet time was modest with additional 12.9\u00a0min in the navigated cohort compared to the conventional cohort. Our findings suggest that the experienced knee surgeons can improve immediately and constantly the accuracy of component orientation using an image\u2010free computer\u2010assisted navigation system in TKA. The computer\u2010assisted technology has shown to be easy to use, safe, and efficient in routine knee replacement surgery. We believe that navigation is a key technology for various current and future surgical alignment topics and minimal\u2010invasive lower limb surgery.<\/jats:p>","DOI":"10.1007\/s00167-007-0420-y","type":"journal-article","created":{"date-parts":[[2007,12,21]],"date-time":"2007-12-21T13:19:04Z","timestamp":1198243144000},"page":"249-257","source":"Crossref","is-referenced-by-count":54,"title":["Improved accuracy of component alignment with the implementation of image\u2010free navigation in total knee arthroplasty"],"prefix":"10.1002","volume":"16","author":[{"given":"Ralf E.","family":"Rosenberger","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hoser","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Quirbach","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Attal","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Hennerbichler","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Medicine Innsbruck Medical University Anichstrasse 35 6020 Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,12,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200104000\u201000022"},{"issue":"11","key":"e_1_2_7_3_1","first-page":"935","article-title":"CT\u2010based and CT\u2010free navigation in knee prosthesis implantation. 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