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The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case–control study

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Previous studies have noted an adverse relationship between implant malalignment during total knee arthroplasty (TKA) and post-operative pain. Although some evidence exists indicating that computer-assisted surgical navigation for TKA can improve the accuracy of component alignment, its impact on clinical outcomes is currently unknown. The dual goals of the present cohort/nested case–control study were to (1) compare self-reported responses to the Western Ontario-McMaster Osteoarthritis Index (WOMAC) questionnaire between computer-assisted TKA (123 patients) using the imageless PiGalileo navigation system and conventional TKA (207 patients) [cohort analysis], and (2) to investigate a potential association between malalignment and post-operative pain in 19 painful knees and 19 asymptomatic knees obtained from the cohort analysis using matched sampling [nested case–control study]. In the cohort analysis, a relevant but non-significant (P = 0.06) difference in the occurrence of chronic pain was observed between the navigated (12%) and conventional arms (20%). Median post-operative WOMAC pain score was 100 (range, 50–100) in the conventional group and 100 (range, 65–100) in the navigated group. However, the Mann–Whitney test revealed a significant difference in favor of the navigated group (P = 0.01). In the nested case–control analysis, radiological outcomes and computer tomography (CT) measurements of femoral rotation were compared between the groups. The CT rotation measurements yielded evidence of a relationship between post-operative pain and incorrect rotational alignment of the femoral component of more than 3° (OR: 7; 95% CI: 1.2–42; P = .033). In conclusion, there was no clinical benefit to computer-assisted navigation; however, a statistically significant relationship was observed between incorrect rotational alignment of the femoral component and symptoms of post-operative pain following TKA.

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Acknowledgments

This study was supported by Smith and Nephew Orthopaedics AG, Switzerland. The authors thank John David Watson, New York, for his editorial comments.

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Authors and Affiliations

  1. Orthopädisches Krankenhaus Gersthof [Orthopaedic Hospital], Wielemansgasse 28, 1180, Vienna, Austria

    Thomas Czurda & Peter Ritschl

  2. Smith and Nephew Orthopaedics AG, Erlenstrasse 4a, 6343, Rotkreuz, Switzerland

    Peter Fennema

  3. Radiologische Abteilung Krankenhaus Hietzing [Department of Radiology, Hietzing Hospital], Wolkersbergenstrasse 1, 1130, Vienna, Austria

    Martin Baumgartner

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  1. Thomas Czurda
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  2. Peter Fennema
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  3. Martin Baumgartner
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  4. Peter Ritschl
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Correspondence to Thomas Czurda.

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Czurda, T., Fennema, P., Baumgartner, M. et al. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case–control study. Knee Surg Sports Traumatol Arthrosc 18, 863–869 (2010). https://doi.org/10.1007/s00167-009-0990-y

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  • DOI: https://doi.org/10.1007/s00167-009-0990-y

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