CTO Hospital, 1st Orthopaedic and Trauma Department, ASST G. P...

PurposeAt the beginning of this century unprecedented interest in the concept of using less invasive approaches for the treatment of knee degenerative diseases was ignited Initial interest in this approach was about navigated and non-navigated knee reconstruction using small implants and conventional total knee arthroplasty MethodsTo this end a review of the published literature relating to less invasive compartmental arthroplasty of the knee using computer-based alignment techniques and on soft tissue-dedicated small implants is presented The authors present and compare their personal results using these techniques with those reported in the current literature These involved the use of a shorter incision and an emphasis sparing However nowadays most surgeons look at compartmental knee resurfacing with the use of small implants as the new customized approach for younger and higher-demand patients The aim of this paper is to stimulate further debate ResultsSince the beginning of 2000 computer-assisted surgery has been applied to total knee arthroplasty TKA and later to compartmental knee arthroplasty Recent studies in the literature have reported better implant survivorship for younger patients using navigation in TKA at longer-term follow-up Only one published report was identified showing superior clinical outcomes at short-term follow-up using computer-assisted technology compared with conventional alignment techniques in small implant surgery No studies were found in the literature that demonstrated similar clinical advantages with navigated small implants at long-term follow-up Two published meta-analyses were identified reporting better implant and limb alignment and no increase in complications using a navigated unicompartmental knee arthroplasty However neither meta-analysis showed superior clinical outcomes or survivorship with the navigated techniques ConclusionIn conclusion we can assert that replacing just the damaged compartment and preserving the normal biomechanics will require not only new implant designs but also new technologies allowing the surgeon to make extremely precise adjustments to implant alignment and providing continuous feedback during surgery Level of evidenceIV

CTO Hospital, 1st Orthopaedic and Trauma Department, ASST G. Pini-CTO, Milan, Italy

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Navigated “small implants” in knee reconstruction