Twelve-Year Follow-Up of Navigated Computer-Assisted Versus Conventional Total Knee Arthroplasty

Cip, Johannes; Obwegeser, Florian; Benesch, Thomas; Bach, Christian; Ruckenstuhl, Paul; Martin, Arno

doi:10.1016/j.arth.2017.12.012

Cited by 57 publications

(69 citation statements)

References 28 publications

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“…As the use of technology-assisted surgery has increased over the past 2 decades, multiple studies have demonstrated improved mechanical alignment with the use of computer navigation and robot-assisted surgeries [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . However, studies have not been conclusive regarding the effects of technology assistance on revision rate, patient-reported outcomes, and complication rates [12] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] . Given the lack of conclusive data, the debate concerning the value of technology-assisted TKA and its cost-effectiveness continues.…”

Section: Introductionmentioning

confidence: 99%

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

et al. 2019

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Background Computer navigation and robotic assistance technologies are used to improve the accuracy of component positioning in total knee arthroplasty (TKA), with the goal of improving function and optimizing implant longevity. The purpose of this study was to analyze trends in the use of technology-assisted TKA, identify factors associated with the use of these technologies, and describe potential drivers of cost. Methods The Nationwide Inpatient Sample database was used to identify patients who underwent TKA using conventional instrumentation, computer navigation, and robot-assisted techniques between 2005 and 2014. Variables analyzed include patient demographics, hospital and payer types, and hospital charges. Descriptive statistics were used to describe trends. Univariate and multivariate analyses were performed to identify differences between conventional and technology-assisted groups. Results Our analysis identified 6,060,901 patients who underwent TKA from 2005 to 2014, of which 273,922 (4.5%) used computer navigation and 24,084 (0.4%) used robotic assistance. The proportion of technology-assisted TKAs steadily increased over the study period, from 1.2% in 2005 to 7.0% in 2014. Computer navigation increased in use from 1.2% in 2005 to 6.3% in 2014. Computer navigation was more likely to be used in the Western United States, whereas robot-assisted TKAs were more likely to be performed in the Northeast. Increased hospital charges were associated with the use of technology assistance ($53,740.1 vs $47,639.2). Conclusions The use of computer navigation and robot-assisted TKA steadily increased over the study period, accounting for 7.0% of TKAs performed in the United States in 2014. Marked regional differences in the use of these technologies were identified. The use of these technologies was associated with increased hospital charges.

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Section: Introductionmentioning

confidence: 99%

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

et al. 2019

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“…Achieving an optimal balance between stability and mobility requires both an accurate pre‐operative planning (to ensure an optimal balancing of the soft tissues), and an accurate execution (to accurately achieve the planned skeletal positioning). In principle, both computer‐aided surgical navigation and patient‐specific instrumentation such as custom‐made cutting guides should ensure accurate execution, but in spite of this both technologies have contradictory reports in terms of clinical outcome . One major limitation is that for all these technologies, pre‐operative planning is performed on static models that provide detailed anatomical information but no functional information.…”

mentioning

confidence: 99%

Pre‐operative prediction of soft tissue balancing in knee arthoplasty part 1: Effect of surgical parameters during level walking

Viceconti

Ascani

Mazzà

2019

Journal Orthopaedic Research

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An important reason for poor functional outcome of Total Knee Arthroplasty is inadequate soft tissue balancing. Custom‐made cutting guides or computer‐aided surgical navigation make possible to accurately achieve what is planned; the challenge is to perform a pre‐operative planning that properly accounts for soft‐tissue balancing. The first step in the development of a patient‐specific computer model that can predict during pre‐operative planning the post‐operative soft‐tissue balancing is a better understanding of the role that cutting heights and angles have on the balancing of the soft tissues after TKA as the patient perform the more common daily tasks. In the present study, we conducted a sensitivity analysis of the ligament elongations during level walking due to TKA as a function of position and orientation of the cutting guides, by means of a validated patient‐specific dynamic model of the post‐TKA knee biomechanics. The results suggest a considerable sensitivity of the collateral ligaments elongation to the surgical variables, and in particular to the varus‐valgus angles of both tibia and femur. This complete elongation map can be used as a baseline for the development of reduced‐order models to be integrated in pre‐operative planning environments. © 2019 The Authors Journal of Orthopaedic Research. Published by Wiley Periodicals, Inc. J Orthop Res 37:1537–1545, 2019.

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“…This low absolute risk means that any study seeking to validate the benefits of a reaming-free procedure in terms of AMI, or other major morbidity or mortality, requires an extremely huge sample size. Recent studies have failed to show superiority for the navigation technique over conventional TKA in terms of clinical results, image findings and survival rates [ 10 , 11 ]. Some researchers have also questioned the role of sealing the femoral canal in mitigating blood loss [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

et al. 2018

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Total knee arthroplasty (TKA) is a well-established modality for the treatment of advanced knee osteoarthritis (OA). However, the detrimental effects of intramedullary reaming used in conventional TKA for distal femur cutting are of concern. Avoiding intramedullary reaming with the use of computer-assisted navigation TKA can not only provide superior prosthetic alignment, but also mitigate perioperative blood loss and the dissipation of marrow emboli. We quantified local and systemic concentrations of inflammation markers for both techniques. Forty-four participants undergoing computer-assisted navigation and 53 receiving conventional TKA for advanced knee OA were recruited between 2013/02/08 and 2015/12/09. Blood samples were collected from all participants at baseline then again at 24 and 72 hours postoperatively and analyzed by ELISA for interleukin 6 (IL-6), IL-10, tumor necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-β1); these markers were also measured in Hemovac drain fluid collected at 24 and 72 hours. Serum levels of IL-6, IL-10, TNF-α and TGF-β1(unit for all markers: pg/mL) were increased from baseline by smaller increments in the navigation TKA cohort compared with the conventional TKA group at 24 hours (17.06 vs 29.39, p = 0.02; 0.51 vs 0.83, p = 0.16; –0.04 vs 0.36, p < 0.01 and –48.18 vs 63.24, p< 0.01, respectively) and at 72 hours (12.27 vs 16.87, p = 0.01; –0.40 vs 0.48, p < 0.01; 0.58 vs 0.98, p = 0.07 and –55.16 vs 63.71, p < 0.01, respectively). IL-10 levels in drainage fluids collected 24 hours after TKA were also significantly lower in the navigation group versus the conventional TKA group (8.55 vs 12.32, p < 0.01). According to our evidence, the merits of computer-assisted navigation TKA are augmented by low levels of inflammation markers.

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Twelve-Year Follow-Up of Navigated Computer-Assisted Versus Conventional Total Knee Arthroplasty

Cited by 57 publications

References 28 publications

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

Pre‐operative prediction of soft tissue balancing in knee arthoplasty part 1: Effect of surgical parameters during level walking

Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

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