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What is the Brainlab Knee Navigation System?

Brainlab KNEE3 is a navigation software from a company called Brainlab for knee-replacement procedures. The software helps to guide the surgeon in performing a computer-assisted total knee replacement surgery to relieve pain and restore the stability and function of your knee.

One of the most important aspects of the total knee replacement procedure is the exact placement of the joint-replacement implants since incorrectly aligned implants can result in an increased chance of wear and loosening of the joint replacement. Brainlab’s Computer-Assisted Surgery (CAS) enables a surgeon to use a computerized model of the knee joint to secure a proper joint alignment based on an individual’s knee and related ligament anatomy.

Brainlab’s surgical navigation software has been shown to improve alignment, stability, and overall function of the new knee joint, thereby ensuring its longevity while reducing the need for revisions.

Working Mechanism of the Brainlab Knee Navigation System

The Brainlab software-guided surgical system continuously tracks various points of the knee anatomy and displays images on a computer screen in the operating room before, during, and after surgery. It helps your surgeon by guiding them through different phases of the procedure. During the surgery, the Brainlab software accurately measures the position of your tibia and femur bones and the surgical instruments in relation to each other, as well as calculates the alignment of the leg to assist with accurate placement of the implant. The system also enables your surgeon to intraoperatively react, verify, and correct treatment steps as needed during surgery.

Knee Anatomy

The knee is made up of the femur (thighbone), tibia (shinbone), and patella (kneecap). The lower end of the thighbone meets the upper end of the shinbone at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone. The bones are held together by protective tissue, ligaments, tendons, and muscles. Synovial fluid within the joint aids in the smooth movement of the bones over one another. The meniscus, a soft crescent-shaped cartilaginous structure between the femur and tibia, serves as a cushion and helps absorb shock during motion.

Indications for Brainlab-Assisted Knee Arthroplasty

Some of the indications that warrant Brainlab-assisted knee arthroplasty include:

  • Chronic progressive joint disease
  • Increased pain in the affected knee
  • Trauma to the knee joint
  • Knee instability or a feeling of giving way while walking
  • Knee pain that interferes with sleep and other activities of daily living
  • Stiffness in the knee
  • Fracture
  • Failed knee arthroplasty
  • Failed conservative treatment

Preparation for Brainlab-Assisted Knee Arthroplasty

Preoperative preparation for Brainlab-assisted knee arthroplasty involves the following steps:

  • A thorough examination of the patient is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on the patient’s medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting surgery.
  • Information regarding any allergies to medications, anesthesia, or latex is obtained.
  • Information is also obtained on any medications, vitamins, or supplements being taken by the patient.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco for at least 24 hours prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself post-surgery.
  • A written consent will be obtained after the surgical process has been explained in detail.

Knee Arthroplasty Procedure Using the Brainlab Knee Navigation System

The surgery is performed entirely under anesthesia. While computer navigation is a tool to guide your surgeon to ensure greater accuracy during knee arthroplasty, it does not replace the skills of your surgeon.

Computer navigation provides your surgeon with real-time 3D images of your mapped knee and the surgical instruments during surgery. The data for the images is provided by infrared sensors fixed to the bones of the knee and surgical instruments. Their position is tracked by an infrared camera placed above the surgical table, which is connected to a computer. The computer then generates real-time images with the help of the Brainlab navigation software to guide your surgeon in precisely following the preoperative surgical plan.

Postoperative Care and Recovery

In general, postoperative care and recovery involve the following steps:

  • You will be transferred to the recovery area to be monitored until you wake from the anesthesia.
  • A staff nurse will monitor your blood oxygen levels and other vital signs as you recover.
  • Once awake, you may experience pain and stiffness in your leg. Pain medications will be provided for comfort.
  • Do not bear weight on the affected leg for at least 24 hours. However, you are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • You are advised to keep your leg elevated while resting to prevent swelling and pain.
  • Medications will also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
  • Instructions on surgical site care, driving, and bathing will be provided.
  • A balanced diet rich in iron supplements is recommended to help your wound heal and to restore muscle strength.
  • You are advised to maintain a healthy weight to minimize stress on the joints.
  • Refrain from smoking as it can negatively affect the healing process.
  • Refrain from strenuous activities or lifting heavy objects for a month or two. A gradual increase in activities over time is recommended.
  • A customized exercise regimen is advised after a few weeks following surgery to strengthen your knee muscles and restore muscle function and range of motion.
  • You should be able to resume most of your normal weight-bearing activities in 4 to 6 weeks, while a return to sports may take 3 to 6 months.
  • A follow-up appointment will be scheduled to monitor your progress.

Benefits of the Brainlab Knee Navigation System

Some of the advantages that the Brainlab knee navigation system provides over conventional knee replacement surgery include:

  • Minimal blood loss
  • Minimal soft tissue damage
  • Improved longevity of the implants
  • Increased postoperative patient satisfaction
  • Better functional outcome
  • Improved soft-tissue balancing
  • Accurate implant positioning
  • Accurate implant alignment, resulting in minimal chance of wear and tear and implant loosening
  • Minimal chance of revision arthroplasty

Risks and Complications

Knee arthroplasty using the Brainlab knee navigation system is a relatively safe procedure; however, as with any surgery, there are associated risks and complications such as the following:

  • Infection
  • Damage to adjacent soft tissue structures
  • Blood clots or deep vein thrombosis (DVT)
  • Anaesthetic complications
  • Persistence of pain
  • Bleeding