The navigation of total knee arthroplasty: intraoperative or preoperative solution

René PAULE

For about 10 years, the development of surgical navigation has allowed a different approach to the knee prosthesis with a number of result we can no longer challenge in terms of alignment member, rotation of the implants and precision of bone cuts.

Machinery necessary for that navigation has allowed a more educational approach with a better understanding of the joint. However, the complexity of its implementation both in terms of organization and operation has used the most motivated of us.

This passage that we are sold as "required" or medico-legal allowed us to return more calmly to the conventional technique. It was therefore a change in the navigation to make things simple by keeping accuracy.

The gamble is about to be held with the advent of pre-operative navigation cutting blocks with single-use measure. Many European and American companies have addressed the issue with varying success in terms of quality.

The principle is simple with the completion of Planning (formerly intraoperatively) a few weeks before surgery. The surgeon keeps a permanent control over the file that allows the realization of CAD cut blocks. These fit very intimate with the femur or tibia allowing millimeter precision cuts.

The technique is simple, reliable, reproducible and faster than the navigation of the past. It's not just a marketing phenomenon but it remains to solve some problems of organization (MRI, scanner), operation (ligament balance) and funding for this solution becomes perenne time.