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Is It Possible to Obtain Reliable MPTA and LDFA Values Using Imageless Navigation in Total Knee Arthroplasty? Comparison Between Preoperative CT Scan Measurements and Intraoperative Bone Morphing Before and After Articular Cartilage Removal (CAR-NAV-AL)

11. mai 2026 oppdatert av: Groupe Hospitalier Diaconesses Croix Saint-Simon

Is It Possible to Obtain Reliable MPTA and LDFA Values Using Imageless Navigation in Total Knee Arthroplasty? Comparison Between Preoperative CT Scan Measurements and Intraoperative Bone Morphing Before and After Articular Cartilage Removal.

Title: Evaluation of Image-less Navigation Accuracy in Total Knee Arthroplasty (CARNAVAL)

Summary:

The purpose of this study is to evaluate the accuracy of an imageless navigation system in measuring key anatomical angles (MPTA and LDFA) during Total Knee Arthroplasty (TKA). While preoperative CT scans are currently the gold standard for bone planning, imageless navigation uses a "bone morphing" technique during surgery to create a digital model of the knee.

The study aims to determine if the measurements obtained via bone morphing, both before and after cartilage removal, are consistent with the measurements obtained from preoperative CT scans. The investigators seek to confirm if imageless navigation can provide reliable anatomical data, potentially reducing the need for preoperative radiation and costs associated with CT imaging.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Background:

Accurate alignment is critical for the long-term success of Total Knee Arthroplasty (TKA). Newer robotic and navigated systems rely on bone morphing to define the patient's anatomy per-operatively. However, the impact of cartilage thickness and the intrinsic accuracy of these systems compared to 3D CT-based planning remain subjects of clinical interest.

Objectives:

The primary objective is to compare the Medial Proximal Tibial Angle (MPTA) and the Lateral Distal Femoral Angle (LDFA) measured by:

Preoperative CT scan (Reference standard).

Peroperative image-less navigation (bone morphing) with intact cartilage.

Peroperative image-less navigation (bone morphing) after cartilage removal.

Methodology:

This is a prospective, monocentric, interventional study. All included patients will undergo a standard preoperative 3D CT scan as part of the surgical planning. During the TKA procedure, the surgeon will use the navigation system to perform bone morphing at two specific stages:

Initial stage: On the joint surface with the cartilage still present.

Secondary stage: After the surgical removal of the articular cartilage.

Comparison:

The data collected peroperatively will be compared to the CT scan measurements. The study will evaluate the "fidelity" (accuracy) of the navigation system and analyze whether the presence or absence of cartilage significantly alters the reliability of the digital bone model created by the system.

Expected Outcomes:

The results will help determine the degree of confidence surgeons can place in imageless navigation for achieving precise anatomical alignment without the systematic use of preoperative 3D imaging.

Studietype

Intervensjonell

Registrering (Faktiske)

50

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Frankrike
      • Paris, Frankrike, 75020
        • Groupe Hospitalier Diaconesses Croix Saint Simon

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen
  • Eldre voksen

Tar imot friske frivillige

Nei

Beskrivelse

Inclusion Criteria:

Patients aged 18 years or older.

Patients with primary or secondary knee osteoarthritis requiring a Total Knee Arthroplasty (TKA).

Patients for whom the surgical planning requires a pre-operative 3D CT scan.

Patients who have been informed about the study and have signed the written informed consent.

Patients affiliated with or beneficiaries of a social security scheme.

Exclusion Criteria:

Revision Total Knee Arthroplasty (re-operation).

Major bone loss or significant bone deformity that prevents reliable anatomical landmarking.

History of prior knee surgery that could interfere with the navigation system trackers (e.g., retained hardware in the femur or tibia).

Pregnant or breastfeeding women.

Persons deprived of liberty or under legal guardianship.

Patients with a known allergy to any component used during the standard surgical procedure.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Helsetjenesteforskning
  • Tildeling: N/A
  • Intervensjonsmodell: Enkeltgruppeoppdrag
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: Navigation and CT-scan Comparison Group)
All participants undergo Total Knee Arthroplasty (TKA) using an imageless navigation system. Anatomical measurements (MPTA and LDFA) are recorded via bone morphing at two stages: 1) on intact articular cartilage and 2) after cartilage removal.
Fremgangsmåte: Non-image-based Computer-Assisted Navigation with Bone Morphing
Intraoperative surface morphing of the joint surfaces is performed to obtain LDFA and MPTA values. The procedure compares measurements taken on the residual cartilage versus measurements taken directly on the osseous surface after cartilage debridement. These values are then validated against preoperative 3D CT scan data.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Mean Difference in Medial Proximal Tibial Angle (MPTA) between CT scan and Imageless Navigation.
Tidsramme: At the time of surgery (intra-operative).
The mean difference (measured in degrees) between the MPTA calculated from the preoperative 3D CT scan and the MPTA measured intraoperatively via bone morphing after cartilage removal.
At the time of surgery (intra-operative).

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Mean Difference in Lateral Distal Femoral Angle (LDFA) between CT scan and Imageless Navigation.
Tidsramme: At the time of surgery (intraoperative)
The mean difference (measured in degrees) between the LDFA calculated from the preoperative 3D CT scan and the LDFA measured intraoperatively via bone morphing after cartilage removal.
At the time of surgery (intraoperative)
Correlation of MPTA and LDFA measurements before and after cartilage removal.
Tidsramme: At the time of surgery (intra-operative).
Evaluation of the measurement shift (in degrees) caused by the presence of articular cartilage during the bone morphing process. This assesses the system's ability to extrapolate the subchondral bone surface.
At the time of surgery (intra-operative).

Samarbeidspartnere og etterforskere

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Sponsor

Groupe Hospitalier Diaconesses Croix Saint-Simon

Etterforskere

  • Hovedetterforsker: Antoine MOUTON, Orthopedic surgeon, Diaconesses Croix Saint Simon Hospital Group

Publikasjoner og nyttige lenker

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Generelle publikasjoner

Studierekorddatoer

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Studer hoveddatoer

Studiestart (Faktiske)

7. juli 2025

Primær fullføring (Faktiske)

30. oktober 2025

Studiet fullført (Faktiske)

30. oktober 2025

Datoer for studieregistrering

Først innsendt

28. april 2026

Først innsendt som oppfylte QC-kriteriene

5. mai 2026

Først lagt ut (Faktiske)

8. mai 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

14. mai 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

11. mai 2026

Sist bekreftet

1. mai 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 2025-A00825-44

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