Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review

Burnett, R. Stephen J.; Barrack, Robert L.

doi:10.1007/s11999-012-2528-8

Cited by 137 publications

(99 citation statements)

References 10 publications

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“…While our findings are consistent with those of numerous other authors that CAS results in a mechanical axis closer to neutral, the clinical benefit of this finding has yet to be clearly demonstrated through the use of accepted clinical evaluation tools [17][18][19][20]. Furthermore, using CAS for TKA involves recurring costs and often results in increased operative time.…”

Section: Discussionsupporting

confidence: 87%

Re-learning curve for conventional total knee arthroplasty following 30 consecutive computer-assisted total knee arthroplasties

Nicholson

Trofa

Smith

2013

Computer Aided Surgery

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A learning curve for returning to conventional total knee arthroplasty (TKA) after using computer-assisted (CAS) TKA has not yet been established. In this study, the postoperative mechanical axes of the first 30 consecutive CAS TKAs performed by a single surgeon were compared to his subsequent 120 conventionally performed TKAs. A ''re-learning curve'' of 30 conventional TKAs was necessary to attain an average postoperative mechanical axis statistically indistinguishable from the average CAS mechanical axis (1.99 ). This is a trend of which surgeons should be aware when converting from CAS TKA to conventional TKA. As a secondary goal, the authors identify the first clinical parameter, preoperative deviation from neutral mechanical axis, that may potentially serve as a guide for the selective use of CAS in TKA.

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Section: Discussionsupporting

confidence: 87%

Re-learning curve for conventional total knee arthroplasty following 30 consecutive computer-assisted total knee arthroplasties

Nicholson

Trofa

Smith

2013

Computer Aided Surgery

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“…A recent systematic review of computer-assisted TKA demonstrated that although many studies support the idea that this technology can improve TKA alignment, there has been a paucity of documented gains in function, patient satisfaction, or survivorship [6]. This review addresses a similar set of questions applied to PSI.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Sassoon

Nam

Nunley

et al. 2015

Clinical Orthopaedics &Amp; Related Research

177

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Background Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions. Questions/purposes We asked: (1) Do patient-specific cutting blocks achieve neutral mechanical alignment more reliably during TKA when compared with conventional methods? (2) Does patient-specific instrumentation (PSI) provide financial benefit through improved surgical efficiency? (3) Does the use of patient-specific cutting blocks translate to improved clinical results after TKA when compared with conventional instrumentation? Methods We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE 1 and EM-BASE 1 with respect to patient-specific cutting blocks and their effect on alignment, cost, operative time, clinical outcome scores, complications, and survivorship. Sixteen studies (Level I-III on the levels of evidence rubric) were identified and used in addressing the first question, 13 (Level I-III) for the second question, and two (Level III) for the third question. Qualitative assessment of the selected Level I studies was performed using the modified Jadad score; Level II and III studies were rated based on the Newcastle-Ottawa scoring system. Results The majority of studies did not show an improvement in overall limb alignment when PSI was compared with standard instrumentation. Mixed results were seen across studies with regard to the prevalence of alignment outliers when PSI was compared with conventional cutting blocks with some studies demonstrating no difference, some showing an improvement with PSI, and a single study showing worse results with PSI. The studies demonstrated mixed results regarding the influence of PSI on operative times. Decreased operative times were not uniformly observed, and when noted, they were found to be of minimal clinical or financial significance. PSI did reliably reduce the number of instrument trays required for processing perioperatively. The accuracy of the preoperative plan, generated by the PSI manufacturers, was found lacking, often leading to multiple intraoperative changes, thereby disrupting the flow of the operation and negatively impacting efficiency. Limited data exist with regard to the effect of PSI on postoperative function, improvement in pain, and patient

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“…Other studies comparing computer-assisted TKA with conventional TKA surgery have not been able to correlate malalignment with inferior functional outcomes (Spencer et al 2007, Kamat et al 2009, Kim et al 2009, Burnett and Barrack 2013). …”

mentioning

confidence: 97%

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

Stučinskas¹,

Robertsson²,

Širka³

et al. 2015

Acta Orthopaedica

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Background and purpose — Postoperative muscle strength and component alignment are important factors affecting functional results after total knee arthroplasty (TKA). We are not aware of any studies that have investigated the relationship between them. We therefore investigated whether coronal malalignment of the mechanical axis and/or of individual implant components would affect knee muscle strength and function 1 year after TKA surgery.Patients and methods — We included 120 consecutive osteoarthritis (OA) patients admitted for TKA. Preoperative active range of motion (ROM) of the knee, patient age, sex, and BMI were recorded and the Knee Society score (KSS) and knee joint extensor/flexor muscle strength were assessed. At 1-year follow-up, the mechanical and coronal component alignment was measured from a postoperative long standing radiograph, and ROM, KSS, and muscle strength measurements were taken in 91 patients. Functional outcome and muscle strength measurements were compared between normally aligned and malaligned TKA groups.Results — 29 of 91 TKAs were malaligned, i.e. they deviated more than 3° from the neutral mechanical axis. 18 femoral components and 15 tibial components were malaligned. Before surgery, the malaligned and normally aligned groups were similar regarding sex distribution, BMI, ROM, KSS, and muscle strength. At the 1-year follow-up, the differences between the groups regarding knee joint function and muscle strength were small, not statistically significant, and barely clinically relevant.Interpretation — Moderate varus/valgus malalignment of the mechanical axis or of individual components has no relevant clinical effect on function or muscle strength 1 year after TKA surgery.

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Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review

Cited by 137 publications

References 10 publications

Re-learning curve for conventional total knee arthroplasty following 30 consecutive computer-assisted total knee arthroplasties

Re-learning curve for conventional total knee arthroplasty following 30 consecutive computer-assisted total knee arthroplasties

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

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