Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies

Abstract

We have undertaken a meta-analysis of the English literature, to assess the component alignment outcomes after imageless computer assisted (CAOS) total knee arthroplasty (TKA) versus conventional TKA. We reviewed 23 publications that met the inclusion criteria. Results were summarised via a Bayesian hierarchical random effects meta-analysis model. Separate analyses were conducted for prospective randomised trials alone, as well as for all randomised and observational studies. In 20 papers (4,199 TKAs) we found a reduction in outliers rate of approximately 80% in limb mechanical axis when operated with the CAOS. For the coronal femoral and tibial implants positions, the analysis included 3,058 TKAs. The analysis for the femoral implant showed a reduction in outliers rate of approximately 87% and for the tibial implant a reduction in outliers rate of approximately 80%. Imageless navigation when performing TKA improves component orientation and postoperative limb alignment. The clinical significance of these findings though has to be proven in the future.

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

“…Long term, malalignment might increase the risk of loosening, instability, wear, and osteolysis [1-3, 6, 9, 18, 20, 24, 30-32]. After a decade of clinical use, computerassisted navigation has resulted in improved alignment but has not eliminated outliers and has not improved the clinical outcome [4,7,26,35]. One recent alternative has been the development of patient-specific instrumentation using MRI or CT imaging to generate patient-specific guides that can be used intraoperatively to control all six degrees of freedom of component alignment, which also controls limb and knee alignment.…”

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

“…Component alignment could then be corrected after the probe check. Most studies reported more accurate alignment with fewer outliers using navigation [1,2]. However, Bauwens et al [18] reported that the alignment of the mechanical axes was similar in the navigation and conventional surgery groups in a metaanalysis of 33 studies.…”

“…Many cohort studies have shown improved prosthetic radiographic alignment associated with the use of computer-assisted navigation when compared to standard instrumentation [1][2][3][4]. The use of computer-assisted surgery has also reduced the risk of malalignment associated with minimally invasive surgery (MIS) [5,6], which has potential issues with component malpositioning arising from the limited surgical view [7].…”

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty

“…Proponents of computer navigation refer to metaanalyses that prove a significant reduction in alignment outliers with the use of navigation [2][3][4]. It is also assumed that computer navigation may improve implant survival, as clinical studies indicate an increased incidence of revision if TKA prostheses are implanted with an axis deviation of more than 3 varus/valgus [3][4][5].…”

“…In recent years, imageless computer navigation has become established as a standard implantation technique for total knee arthroplasty (TKA) [1,2]. Proponents of computer navigation refer to metaanalyses that prove a significant reduction in alignment outliers with the use of navigation [2][3][4].…”