• Yoshitomo Saiki, Tomohiro Ojima, Tamon Kabata, Seigaku Hayashi, and Hiroyuki Tsuchiya.
• Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-0934, Japan.
• Arch Orthop Trauma Surg. 2021 Dec 1; 141 (12): 2267-2276.

PurposeIt remains to be established whether optical computed tomography (CT)-free and acceleration-based navigation systems differ in terms of implantation accuracy and clinical outcomes for total knee arthroplasty. This randomised prospective study compared the implantation accuracy of these two navigation systems in total knee arthroplasty.MethodsOptical CT-free navigation (ExactechGPS) or acceleration-based navigation (KneeAlign2) was randomly assigned to the left or right knee of 45 patients who underwent a single-stage bilateral total knee arthroplasty: the ExactechGPS (n = 45) and KneeAlign2 groups (n = 45) were compared. Component alignments were evaluated using three-dimensional computed tomography and radiography at pre- and post-surgery. Implantation accuracy of the component alignment, proportion of outliers, postoperative range of motion, and Japanese Orthopaedic Association (JOA) score were compared between the systems.ResultsThe implantation accuracies of the lower-extremity mechanical alignment, coronal femoral component angle, coronal tibial component angle, sagittal femoral component, axial femoral angle, and axial tibial angle had no significant difference between the groups. The implantation accuracy of the sagittal tibial component angle was superior in the ExactechGPS than the KneeAlign2 group (1.3° vs. 1.8°, P = 0.034). The proportions of outliers, range of motion, and JOA score had no significant difference between the groups.ConclusionIn the tibial sagittal plane, there was a significant difference in the implantation accuracy, but its difference did not affect the clinical outcomes. Both navigation systems have clinically acceptable implantation accuracy.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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