A Comparison of Short-Term Outcomes of Minimally Invasive Computer-Assisted vs Minimally Invasive Conventional Instrumentation for Primary Total Knee Arthroplasty

BackgroundSystematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.MethodsWe searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.ResultsBased on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.ConclusionsDespite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.

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“…Also, we contacted experts in the field resulting in one more article eligible for inclusion. As a result, we included 42 SRs 12–14 36–74…”

Section: Resultsmentioning

confidence: 99%

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

Hasan

Zhang

Beal

et al. 2020

BMJ Surg Interv Health Technologies

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“…The number of operating instrumentation trays can be reduced with navigation. Numerous recent studies have described improved functional outcome in the CAOS group compared to the traditional instrumented group [ 29 , 30 , 47 ]. The revision burden from failed TKA and THA includes costlier implants, multiple prolonged hospital admissions, antibiotics, blood products, social services and costs.…”

Section: Discussionmentioning

confidence: 99%

“…These studies are underpowered for detection of functional improvement. But now there is evidence in the literature including meta-analysis that CAOS along with improved anatomical accuracy leads to functional improvement too [ 21 , 29 , 30 ].…”

Section: Methodsmentioning

confidence: 99%

Computer assisted navigation in total knee and hip arthroplasty

Deep

Shankar

Mahendra

2017

SICOT-J

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Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

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“…Three patients of CON group referred feelings of instability during walking, but clinical tests were all negative. NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis, lateral distal femoral components and to more precisely restore the mechanical axis of lower limbs [2,3,9,13,17,20,22,29,32,37]. Literature data show that CAS increases the accuracy of the crucial proximal tibial cut and offers the capability to track independent lengthening and shortening of the collateral ligaments to facilitate the sizing of a femoral component that properly tenses these ligaments through a full range of motion [5,10,41].…”

Section: Introductionmentioning

confidence: 99%