Handheld, accelerometer‐based navigation versus conventional instrumentation in total knee arthroplasty: a meta‐analysis

Abstract

Background: Precise and accurate alignments in total knee arthroplasty are important predictors for survivorship and functional outcomes. We aim to compare accelerometer-based navigation (ABN) to conventional instrumentation (CONV), patient-specific instrumentation (PSI) and computer-assisted surgery (CAS) in published literature. Methods: A systematic search of publications from databases (MEDLINE, EMBASE and Cochrane) was obtained from inception to 15 August 2018. A random-effects meta-analysis was used to pool odd ratios for outliers greater than 3 for the hip-knee-ankle, coronal and sagittal femoral and tibial angles (CFA, CTA, SFA, STA). Secondary outcomes included procedural characteristics and functional outcomes. Results: Thirteen studies, involving 1566 patients, met inclusion that compared ABN (50.2%) to CONV (49.8%) and five comparing ABN to CAS/PSI. The pooled odds ratios for percent outliers of greater than 3 from the mechanical axis for the hip-knee-ankle (relative risk 0.58, P = <0.05) and CFA (relative risk 0.42, P = 0.02) was significantly lower for ABN compared to CONV. The pooled odds ratios for CTA, SFA and STA were not significantly different. No differences were identified in comparison to PSI/CAS. There was no statistically significant difference in procedural characteristics and functional outcomes. Conclusions: The use ABN in total knee arthroplasty is a successful method of increased precision and accuracy for the restoration of the mechanical axis. In addition, there is no significant compromise in procedural or functional outcomes.

No difference in clinical outcomes between portable navigation and conventional instrumentation in total knee arthroplasty: A randomised trial

“…They concluded that larger samples and longer follow‐up periods are required to support the trend of better patient outcomes using CAS in TKA. A recent meta‐analysis by Shihab et al concluded neither individual studies nor pooled mean differences found PAD was statistically superior in improving any patient‐reported outcome variable (Knee Society Score, Oxford Knee Score and SF‐36) with at least 6‐month follow‐up 5 …”

“…A marginal, but non‐statistically significant, improvement in the coronal and sagittal prosthetic alignment was found in the PAD group. Other studies have demonstrated high rates of precision using PAD in restoration of individual component and overall lower limb alignment 1–5 …”

“…Other studies have demonstrated high rates of precision using PAD in restoration of individual component and overall lower limb alignment. [1][2][3][4][5] Although this alignment method shares similar characteristics with CAS, it cannot be assumed that PAD will achieve similar patient outcomes. There is limited and inconclusive evidence correlating the greater precision of CAS with improvements in patientreported outcome measures (PROMs).…”

“…Although this alignment method shares similar characteristics with CAS, it cannot be assumed that PAD will achieve similar patient outcomes. There is limited and inconclusive evidence correlating the greater precision of CAS with improvements in patient‐reported outcome measures (PROMs) 5–10 . Notably, there is a paucity of data comparing differences in PROMs between PAD and CON 3,5,11–13 .…”

Accelerometer-based, hand-held navigation for improved knee alignment in total knee arthroplasty: An observational study

“…A literature search showed no specific cut off values of rotational mal-alignment prediction revision rates and till date one study by Gharaibeh et al 10 has compared the difference in FCR and found an insignificant reduction in the outliers in the ABN group compared to the conventional group. 32 As the femoral component rotation in ABN is set by conventional methods we searched studies that have compared component rotations obtained in conventional technique with that of the CAS 33,34 and Patient specific instrumentation (PSI) 35 . They reported significantly better rotational placement obtained with the CAS but the data regarding the failure of TKA with respect to rotational mal-alignment in these cohorts have not been reported.…”