Clinical outcome using a ligament referencing technique in CAS versus conventional technique

Abstract

PurposeComputer-assisted surgery (CAS) for total knee arthroplasty (TKA) has become increasingly common over the last decade. There are several reports including meta-analyses that show improved alignment, but the clinical results do not differ. Most of these studies have used a bone referencing technique to size and position the prosthesis. The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs.MethodsWe performed a prospective cohort study comparing clinical outcome of navigated TKA (43 patients) with that of conventional TKA (122 patients). Patients were assessed preoperatively, and 2 and 12 months postoperatively by an independent study nurse using validated patient-reported outcome tools as well as clinical examination.ResultsAt 2 months, there was no difference between the two groups. However, after 12 months, CAS was associated with significantly less pain and stiffness, both at rest and during activities of daily living, as well as greater overall patient satisfaction.ConclusionThe present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score (P = 0.002) and Knee Society score (P = 0.040) 1 year after surgery in using a ligament referencing technique. Furthermore, 91% were extremely or very satisfied in the CAS TKA group versus 70% after conventional TKA (P = 0.007).

A prospective randomized study comparing navigation versus conventional total knee arthroplasty

“…16 Many studies found no significant difference in satisfaction, pain or quality of life outcome; however, this conclusion is somewhat heterogeneously reported. 19,20 Neutral MA plays a very pivotal role in the success of longevity of an implant prosthesis and validates postsurgical clinical and functional outcomes.…”

Navigation in surgery

“…The usability and ease-of-use is still improvable and considered the prevailing limiting factor for mass acceptance [22, 34]. There is a learning curve the surgeon and the surgical team need to go through for each indication supported by navigation.…”

Computer Assisted Orthopedic Surgery in TKA

“…However, Choong et al (Choong et al, 2009) reported patients that underwent navigation assisted surgery showed precise limb alignment (<3°), and concluded that accuracy improved new knee function and quality of life. Lehnen et al (Lehnen et al, 2010) reported, in a 1-year follow up study, that Western Ontario and McMaster University (WOMAC) scores and Knee Society scores of 43 navigation assisted surgery patients were notably higher than those of 122 patients that underwent conventional surgery. Patient satisfaction was 91% in the navigation assisted group, but only 70% in the conventional surgery group.…”