e conducted this prospective randomised and externally evaluated study to investigate whether the use of a navigation system during total knee arthroplasty leads to significantly better results than the hand-guided technique. A total of 240 patients was included in the study. All patients received a condylar knee prosthesis. Two surgeons performed all the operations using the Stryker knee navigation system. Exclusion criteria included the necessity for the primary use of constrained implants. The results revealed a highly significant difference between the two groups in favour of navigation with regard to the mechanical axis, the frontal and sagittal femoral axis and the frontal tibial axis (p < 0.0001). The use of a navigation system was therefore shown to improve the alignment of the implant.

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Up to now robotics play a minor role in orthopedic surgery because the financing and daily costs of these devices overburden the budgets of normal hospitals. The technical demands are time consuming and pose an additional cost factor. The trauma to the patients in the opinion of some authors is considerable. Nevertheless, robotics play an important role in the further development of orthopedic surgery because improvements in technology will lead to a better operative outcome for the patients. Navigation devices have been developed in the last few years in different centers. From the medical point of view, it is important that navigation systems support surgeons in the analysis of all questions concerning alignment. This pertains not only to rotation analyses of the femur and tibia components but also to analyses of the cinematic gap in flexion and extension. The handling of soft tissues has an important influence on the postoperative function of the knee. It is also a medical issue that the navigation systems should be open, i.e., that different designs of implants could be implanted with one navigation device. There are some systems which offer this quality. Improvements in technology are necessary especially in rotation analyses of the lower limb.

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