Computer assisted navigation in total knee and hip arthroplasty

Abstract

Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements

“…These findings are consistent with two other studies, 44,45 though they could not be included in our pooled analysis because risk estimates for dislocation risk were not available. Though computer-assisted surgical techniques improve cup position in THR surgery 46 and are increasingly being adopted by surgeons, 47 little evidence exists to show they actually improve outcomes and reduce complication rates in total joint replacement. 44,45,48,49 In the United States, it has been estimated that there will be an increase in the demand of primary THRs by 174% between 2005 and 2030.…”

The Effects of Programmed Cryotherapy and Continuous Passive Motion in Patients after Computer-Assisted Total Knee Arthroplasty: A prospective, randomized controlled trial

“…In this paper, the research results showed that constructive systematic nursing measures have significantly different effects on pain intensity after TKA. The literature indicated that patients who undergo computer-navigated surgery do not suffer from a serious loss of blood or pain because intramedullary nailing of the femur is not required for CAS-TKA [15]. The findings showed that the use of CPM devices can relieve pain intensity after surgery and that it is an appropriate rehabilitation exercise for alleviating pain.…”

The Effects of Immediate Programmed Cryotherapy and Continuous Passive Motion in Patients after Computer-Assisted Total Knee Arthroplasty: A prospective, randomized controlled trial

“…In this paper, the research results showed that constructive systematic nursing measures have signi cantly different effects on pain intensity after TKA. The literature indicated that patients who undergo computer-navigated surgery do not suffer from a serious loss of blood or pain because intramedullary nailing of the femur is not required for CAS-TKA [27]. The ndings showed that the use of CPM devices can relieve pain intensity after surgery and that it is an appropriate rehabilitation exercise for alleviating pain.…”