Electromagnetic Navigated Versus Conventional Total Knee Arthroplasty—A Five-Year Follow-Up of a Single-Blind Randomized Control Trial

Clark, A; Hounat, Adam; O'Donnell, Sinéad M; May, Petra; Doonan, James; Rowe, Peter; Jones, Bryn; Blyth, Mark

doi:10.1016/j.arth.2021.06.007

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…This prospective study provides long-term follow-up results of a randomised controlled trial comparing navigated and conventional TKA. Previously, we have demonstrated at 5 years after surgery that there was a trend towards a higher revision rate in the conventional TKA cohort [ 4 ]. The ten-year results, however, show that there is no discernible difference in all-cause revision or PROMS between the groups at this time point.…”

Section: Discussionmentioning

confidence: 99%

“…Mean tourniquet times were longer in the navigation group (80 vs 65 min, p = 0.001). There was no difference in the PROMs at either 1 or 5 years, but there appeared to be a trend in higher revision rate at five years in the conventional group compared to the navigation group (4.9 vs 0%, p = 0.08) [ 4 ]. The aim of this paper is to report the revision rates and PROMs at 10 years, with our hypothesis being that there would be no difference detected between the two interventions.…”

Section: Introductionmentioning

confidence: 99%

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No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

Farhan-Alanie

Altell

O'Donnell

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Computer-assisted surgery (CAS) total knee arthroplasty (TKA) remains a controversial area of surgical practice. The aim of this study is to report the ten-year revision rates and patient-reported outcome measures (PROMS) of a single-blinded, prospective, randomised controlled trial comparing electromagnetically (EM) navigated and conventional TKA. Methods 199 patients were randomised to receive either EM navigated or conventional TKA where the aim of implantation was neutral mechanical alignment in all cases. Ten-year revision rates were collated and compared between the two intervention groups. Longitudinal PROMS data was collected prospectively at various time points up to 10 years post-operatively. Results Over the ten-year period, there were 23 deaths (22.8%) in the EM navigation cohort and 30 deaths (30.6%) in the conventional cohort. At 10 years post-operatively, there was no statistically significant difference in all cause revision between the EM navigation and conventional cohort (4.0 vs 6.1%, p = 0.429). When analysing causes of revision that might be influenced by utilising EM navigation, there was no statistically significant difference in revisions (3.0% EM navigated vs 4.1% conventional group, p = 0.591). Patients that received navigated TKAs had improved Oxford Knee Society, American Knee Society Score and range of motion at 3 months following surgery compared to conventional TKA (p = 0.002, p = 0.032, and p = 0.05, respectively). However, from 1 to 10 years post-operatively, both interventions had equivalent outcomes. Conclusion There is no difference in revision rates or clinical outcomes comparing EM navigated versus conventional TKA at ten-year follow-up. The expected mortality rate makes it unlikely that a difference in revision rates will reach statistical significance in the future. In the setting of an experienced knee arthroplasty surgeon, it is difficult to justify the additional costs of CAS in TKA surgery. Level of evidence I

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

Farhan-Alanie

Altell

O'Donnell

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…None of the prostheses reports had any authors from the United States. The countries with the most authors were from the United Kingdom in seven reports, 11,12,23,[30][31][32][33] Japan in four reports, 13,[34][35][36] South Korea in three reports, [14][15][16] and two reports each for both the People's Republic of China 17,18 and the Netherlands. 19,20 There was one report each from Australia, 21 Austria, 22 Canada, 24 Denmark, 25 Germany, 26 India, 27 Singapore, 28 and Turkey (►Table 2).…”

Section: Countries Of Originmentioning

confidence: 99%

Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty

et al. 2022

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Introduction: Randomized controlled trials (RCTs)are regarded as highest level of scientific evidence. There is belief that while prospective randomized control trials (PRCTs) are the gold standard for evaluating efficacy of interventions, there are very few conducted on lower extremity joint arthroplasty. However, there was a more than adequate amount (n=197) of published RCTs in knee arthroplasty during the 2021 calendar year. Therefore, we studied RCTs on knee arthroplasties for 2021 and assessed them for overall study topic reasons (i.e., devices as well as prostheses, rehabilitation, pain control, blood loss [tranexamic acid], and other), which were then subcategorized by: (1) country of origin; (2) sample size; and (3)whether or not they were follow-up studies. After this, we specifically focused on the studies (n=26) concerning devices or prostheses. Methods: A search of PubMed on “knee arthroplasty” specifying “RCT” using their search function and dates between January 1, 2021 to December 24, 2021 resulted in the analyzed reports. A total of 17.3% reports analyzed rehabilitation methods while 28.4% studied pain control. A total of 20.3% examined blood loss topics and 20.8% investigated other topics. Results: We found that 26 studies (13.2%) involved prosthetic design and implantation. Overall, only 15% knee arthroplasty RCTs were conducted in the United States, the mean total final sample size was 133±146 patients, and 7% were follow-up studies. None of the prostheses studies were performed in the United States, and the mean total final sample size of all of these studies was 86±54 patients, and 23% were follow-up studies. Total knee arthroplasty prospective RCTs were not performed in the United States. Conclusion: The authors believe that other study designs, such as database or registry analyses, are also appropriate in this rapidly advancing field of joint arthroplasty for the continuing evaluation and approval of new prostheses and techniques, while we await more PRCTs in our field.

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“…The odds ratio for 30-day mortality for technology-assisted compared with conventional bilateral-simultaneous TKA after adjusting for age, sex, and procedure year was 0.26 (p = 0.02), a significant reduction in mortality 47 . In a single-blinded RCT comparing conventional TKA with electromagnetic computer-navigated TKA, Clark et al found no significant differences in PROMs at the 5-year follow-up 48 . A separate report comparing freehand balancing with sensor-guided balancing at a minimum follow-up of 2 years showed no significant differences in knee range of motion, length of stay, opioid consumption, VAS pain scores, surgical complications, or PROMs.…”

Section: Primary Tkamentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa

Singh

Higuera-Rueda

2022

Journal of Bone and Joint Surgery

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Over the past year, areas of investigation in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) such as bleeding control, thromboprophylaxis, pain management, technology-assisted surgery, and infection received major attention. We have included selected studies, many at the highest Levels of Evidence, in an attempt to summarize the most relevant recent findings. Economics of Added TechnologyAhmed et al. 1 evaluated the adoption of computer-assisted knee arthroplasty between the first quarter of 2010 and the third quarter of 2017 in the states of New York and Florida, making use of 2 statewide administrative databases (the Statewide Planning and Research Cooperative System in New York and the Florida Administrative Data in Florida). The proportion of computerassisted knee arthroplasty increased from 4.89% to 9.45% in New York, and from 4.03% to 5.73% in Florida. In New York, that represented a 93.3% growth in utilization. One of the reasons preventing the widespread adoption of these new technologies is their increased costs. In a Markov model, Rajan et al. 2 ascertained the cost-effectiveness of robotic-assisted TKA compared with conventional TKA. Robotic-assisted TKA produced 13.55 qualityadjusted life-years (QALYs) compared with 13.29 QALYs for conventional TKA. Because of its higher QALYs, robotic-assisted TKA remains cost-effective despite being associated with higher costs as long as annualized revision rates stay <1.6%. The costutility of patient-specific instrumentation for TKA compared with the standard of care among patients with a body mass index (BMI) of >30 kg/m 2 was evaluated; patient-specific instrumentation was more costly and less effective 3 . A secondary analysis of a randomized clinical trial (RCT) comparing closed-incision, negative-pressure therapy with the standard of care after revision TKA revealed that the total per-patient costs for surgical-site management were $1,047 for closed-incision, negative-pressure therapy and $2,036 for the standard of care 4 . Knee OsteoarthritisGenetic markers seem to play a role in advanced knee osteoarthritis. Utilizing clinical and genomic data, investigators showed that age and BMI contributed more to the risk of developing end-stage disease than genetic factors. However, 7 genetic loci were significantly associated with end-stage osteoarthritis. The effects of genetic factors were greater in patients who were <60 years of age 5 . The use of hyaluronic acid and platelet-rich plasma remains controversial. Among Medicare patients, hyaluronic acid utilization increased from 1,090,503 patients in 2012 to 1,209,489 patients in 2018 (p = 0.04), and total costs related to hyaluronic acid services increased from $290.10 million to $325.02 million (p < 0.01) 6 . In patients with hemophilic knee arthritis, a trial compared the effects of platelet-rich plasma injections with those of placebo on outcomes over a 24-month follow-up. There were no clinically important differences in the Western Ontario and McMaster Universities Osteoarthritis I...

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Electromagnetic Navigated Versus Conventional Total Knee Arthroplasty—A Five-Year Follow-Up of a Single-Blind Randomized Control Trial

Cited by 8 publications

References 19 publications

No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty

What’s New in Adult Reconstructive Knee Surgery

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