Imageless Computer Navigation in Total Knee Arthroplasty Provides Superior Short Term Functional Outcomes: A Meta-Analysis

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Abstract

Computer navigation in total knee arthroplasty (TKA) is intended to produce more reliable results, but its impact on functional outcomes has not been firmly demonstrated. Literature searches were performed for Level I randomized trials that compared TKA using imageless computer navigation to those performed with conventional instruments. Radiographic and functional outcomes were extracted and statistically analyzed. TKA performed with computer navigation was more likely to be within 3° of ideal mechanical alignment (87.1% vs. 73.7%, P < .01). Navigated TKAs had a higher increase in Knee Society Score at 3-month follow-up (68.5 vs. 58.1, P = .03) and at 12–32 month follow-up (53.1 vs. 45.8, P < .01). Computer navigation in TKA provides more accurate alignment and superior functional outcomes at short-term follow-up.

Section snippets

Protocol

This is a meta-analysis of all Level I randomized controlled trials comparing conventional primary TKA versus TKA using imageless computer-assisted navigation in the English language literature. Our meta-analysis was conducted with guidance by the Cochrane Handbook for Systematic Review of Intervention Version 5.1.0 [10] and with additional input from the PRISMA Statement [11].

Search Strategy

We searched MEDLINE via PubMed, EMBASE via OVID, Scopus, and the Cochrane Central Register of Controlled Trials

Study Selection

Our search strategy produced 1,350 results (MEDLINE n = 407, EMBASE n = 398, Scopus n = 460, and CENTRAL n = 85) with 566 unique papers that were published through December 2012 (Fig. 1). After screening the abstracts for appropriate randomized controlled trials, we were left with 49 papers. Of these, eight were eliminated for inappropriate outcomes (i.e. gait analysis, fat emboli, blood loss or component rotation) 19., 20., 21., 22., 23., 24., 25., 26.. Three were eliminated for using image-based (CT)

Summary of Evidence

The results of our meta-analysis demonstrate that the use of imageless computer navigation in TKA leads to more accurate alignment. Knees in the CAS groups were more likely to have a mechanical axis within 3° of neutral (0°) and a smaller degree of deviation from neutral when measured in absolute terms. There was no significant difference when comparing the mean of the measured mechanical axes; this is likely a result of the neutralizing effect of combining the positive and negative values used

Conclusions

These results demonstrate that the use of computer navigation in TKA achieves both superior mechanical alignment and an increase in functional scores. This increase requires the investment of additional time and financial resources.

It is important to remember that computer navigation is an emerging technology that was only recently developed and is still undergoing growth and improvement. As consumer electronics become smaller and cheaper with the progression of time [73], there is no reason to

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  • Cited by (0)

    There were no external sources of funding for this study.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.09.018.

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