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Navigation in Total Knee Arthroplasty

This is a technique in which a series of infrared cameras are used in conjunction with reflective markers which are placed on the patient's leg above and below the knee. We then use a computer program which collects the data which is used to help direct the proper placement of the knee replacement. The goal is to have a perfectly "aligned" knee in every case. We did a series of cadaver studies and a series of clinical (live patient) studies and found little difference in the standard alignment technique versus the navigation. There are now quite a few studies published, some show no differences, others show some improvement with navigation. Navigation can add some time to the surgical procedure, thus prolonging the time the patient is under anesthesia, and there are some reports of problems due to the metal pins which are placed into the bones above and below the knee holding the reflective markers. Navigation seems to be declining in use in this country. We still use it in our practice when prior surgical procedures or abnormal anatomy do no allow for the use of standard instrumentation. With continued development, navigation may become easier to use and less time consuming.