Clinical and radiographic outcomes of Image-Based Computer-Assisted Total Knee Arthroplasty: An Evidence-based Evaluation

Abstract

Conventional instrumentation systems have limited accuracy in determining the crucial landmarks needed for alignment in total knee arthroplasty (TKA). Given this, the image-based navigation system was introduced to improve the accuracy of implantation of components into the femur and tibia. PubMed, EMBASE, Web of Science, and Evidence-Based Medicine databases were electronically searched to identify eligible studies published until October 2008. A systematic review and meta-analysis of 6 randomized/quasi-randomized controlled trials that compared image-based navigation and conventional techniques was conducted. The operative time was longer in the navigation group in 3 studies. Moreover, there was a higher rate of achieving mechanical leg axis within the range of 3° deviation in patients undergoing navigated TKA. However, all studies between the 2 groups were similar in range of motion, knee scores, and postoperative complication rates at the last follow-up. Overall, these short-term follow-up trials show that there were similar early clinical outcomes between image-based navigation and conventional techniques.

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

“…Six radiological outcomes were compared for TKA (figure 3). Mechanical axis malalignment: 12/15 SRs showed significantly less malalignment with CA TKA12 14 37 43 46–48 51 54 57 60 66 73 whereas 3/15 SRs showed no significant difference 13 64 65. Coronal plane femoral malalignments: six out of eight SRs showed significantly less malalignments with CA TKA,12 14 43 47 57 60 whereas two out of eight SRs showed no difference 13 64.…”

“…Also, we contacted experts in the field resulting in one more article eligible for inclusion. As a result, we included 42 SRs 12–14 36–74…”

Patient-specific template shortens the operative time in total knee arthroplasty in comparison to the conventional technique

“…Contrary to our findings, some recent results were drawn by Abane et al 14 who conducted a multicenter randomized controlled trial and found that operative time, blood loss, and length of hospital stay were not significantly different between the two techniques (P ¼ 0.09, 0.58 PST and 0.50 conventional). Also, Cheng et al 15 found that computerassisted TKA (using navigation) had no benefit in clinical functional outcome or complications compared to conventional technique, and operative time was 18 min longer.…”

Assessment of knee alignment with varus and valgus force through the range of flexion with non-invasive navigation

“…The goal of navigated knee arthroplasty is to increase the precision of implant positioning -to place components more frequently within the biomechanical parameters thought to be associated with the highest patient function and greatest survivorship. A number of randomised control trials [13][14][15] and metaanalyses [16,17] have suggested that knee navigation systems can improve precision of implant alignment within the margin of error of 0±3°, which may lead to improvements in functional scores and survivorship. However, the belief that the 'well-aligned' TKA equates to improved outcome has been challenged by some authors [18,19].…”