Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up.

Knee

Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yisan Road, Shanghai 200233, People's Republic of China.

Published: August 2012

AI Article Synopsis

  • The study investigates whether computer-assisted navigation systems (CAS) improve outcomes in total knee arthroplasties (TKAs) compared to conventional techniques, given that existing long-term data is limited.
  • Conducted per systematic review guidelines, the research analyzed 21 studies involving 2,333 knees and compared surgical times, postoperative complications, and clinical scores between the two methods.
  • Results showed no significant differences in short-term outcomes between CAS and conventional TKAs, prompting a call for more rigorous and long-term studies to evaluate the true benefits of navigation-assisted surgery.

Article Abstract

Purpose: Even though computer-assisted navigation systems have been shown to improve the accuracy of implantation of components into the femur and tibia, long-term results are lacking and there is little evidence yet that navigation techniques also improve functional outcomes and implant longevity following total knee arthroplasty (TKA). The aim of this study was to summarize and compare the clinical outcomes of total knee arthroplasties (TKAs) performed using navigation-assisted and conventional techniques.

Methods: The study was conducted according to the guidelines described in the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements. Methodological features were rated independently by two reviewers. A meta-analysis of randomized controlled trials (RCTs) or quasi- randomized controlled trials (qRCTs) was carried out to evaluate the efficacy of CAS versus conventional TKA. Data were pooled in fixed and random effects models and the weighted mean difference (WMD) and odds ratio (OR) were calculated. Heterogeneity across studies was determined, and subgroup analyses by the type of navigation system (image-based or image-free navigation system) were conducted.

Results: Twenty-one studies that included 2333 knees were collected from different countries. The surgical time was longer for CN TKA than for the conventional procedure. There was no significant difference in the Knee Society Score between the two groups at the 3-month and 6-month follow-up. The rates of postoperative complications in patients who had CN TKA were similar to those in the patients who had conventional TKA.

Conclusion: No significant differences in short-term clinical outcomes were found following TKAs performed with and without computer navigation system. However, there is clearly a need for additional high-quality clinical trials with long-term follow-up to confirm the clinical benefits of computer-assisted surgery.

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http://dx.doi.org/10.1016/j.knee.2011.10.001DOI Listing

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