Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty

Abstract

It remains unclear if computer-assisted surgery (CAS) technique actually improves the clinical outcomes of total knee arthroplasty (TKA) and decreases the failure rate. The purpose of this retrospective study was to compare the functional results of TKA in a series of patients who underwent staged bilateral TKAs with CAS TKA in 1 knee and conventional TKA in the contralateral knee. From January 1997 to December 2010, we collected 60 patients who were randomly assigned to receive CAS TKA in 1 limb and conventional TKA in the other. The Brainlab Vector Vision navigation system was used for CAS TKA, and the DePuy press-fit condylar sigma guide system was used for conventional TKA. Patients were assessed before surgery, 3 months and 1 year after surgery, and annually thereafter. IKS criteria were used for radiographic evaluation. Clinical and functional evaluation using the scoring system of hospital for special surgery (HSS), international knee society (IKS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form-36 (SF-36) were obtained on each knee, before surgery, and at each follow-up visit. Pertinent statistical methods were adopted for data analysis. Fifty-six patients were available for analysis and 44 of the patients were female. The mean duration of follow-up was 8.1 years. Less blood loss (P = .007) and longer operation time were noted for CAS TKAs when compared with conventional TKAs. Precise alignment and fewer outliers of the lower limb and prosthetic component positions were found for CAS TKAs (P < .001). There were no differences between the 2 groups before surgery and at the latest follow-up with regard to scores for HSS, IKS, WOMAC, and SF-36 as well as active range of motion. The clinical outcomes of CAS TKAs at the 8-year follow-up were similar to those of conventional TKAs despite the better radiographic alignment and fewer outliers achieved with navigation assistance.

Computer and robotic – assisted total knee arthroplasty: a review of outcomes

“…Accuracy of CAS TKA compared to conventional TKA Alignment and implant accuracy outcomes have received the most attention in the literature. Nearly all studies show better accuracy of CAS TKA compared to conventional methods [16][17][18][19][20][21][22][23][24][25][26][27][28]. Interestingly, the benefit of navigation appears most consistent in the coronal plane.…”

Comparison of the clinical effects of computer-assisted and traditional techniques in bilateral total knee arthroplasty: A meta-analysis of randomized controlled trials

“…The choice of surgical treatment within a certain period can avoid the risk of uncertainty caused by individual differences such as body mass index, level of activity, knee deformity, and osteoporosis. Each patient was as self-control through bilateral knee joints, making the knee function outcomes more accurate and objective than using different individuals as control and avoiding the impact of physical and mental factors [12,18,19]. The objects included in the study had similar leg alignment (mechanical axis) before surgery on both sides (13.2±6.93 vs 13.1±5.84, p = 0.976).…”

“…There are different opinions from randomized controlled tests (RCTs) on the efficacy of computer-assisted and traditional TKA [12][13][14][15][16][17], whether the reason for the different conclusions is that these two surgical techniques are separately carried out in different patients. Because of the differences in the bone development form of lower limbs, bone quality(affected by differences in age, sex, or body mass index) and personal subjective factors(may be affected knee functional scores) in different patients [12,18,19], the conclusion may be biased. We regard these differences as individual differences.…”

“…However, it is also reported that there is no difference between computer-assisted TKA and traditional TKA in eliminating outliers [ 10 , 11 ]. So, comparing with conventional TKA, whether computer-assisted TKA can improve radiographic results and functional outcomes has still been controversial [ 4 , 12 ].…”

“…We regard these differences as individual differences. Recently, the RCTs of computer-aided and traditional TKA in the same person reported [ 12 , 20 – 22 ], which the aim is to reduce the adverse effect of individual differences on the conclusion. Published meta-analyses showed that the radiographic results and clinical efficacy of computer-assisted and conventional TKA did not include consideration of individual differences [ 17 , 23 ] Whether individual differences lead to contradictory research results is not very clear from the current reports.…”