No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty

Abstract

Purpose Accurate implant position in total knee arthroplasty (TKA) can potentially lead to better long‐term functional outcomes and implant survival. Recent studies on whether better clinical results could be obtained from computer‐navigated or conventional TKA were inconclusive. In addition, recent reviews only included short‐term follow‐up studies without performing quantitative mid‐ to long‐term follow‐up analysis. Thus, the purpose of the present study was to perform a meta‐analysis comparing mid‐ to long‐term clinical outcomes (such as knee scoring and functional results) and radiological outcomes (such as normal alignment of the limb axis or component) between computer‐navigated TKA and conventional TKA to determine which method of TKA could obtain better clinical and radiological results. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases were searched for relevant articles published through August 2018 that compared outcomes of computer‐navigated TKA and conventional TKA. Data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. Clinical and radiological outcomes of both techniques were evaluated using various outcome measures. Results Seven randomized controlled trials were included. Based on Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, pain, and range of motion, there were no significant differences in clinical outcomes between the two techniques. Based on outliers from the normal axis, outliers of femoral components in the coronal plane, and outliers of tibial components in the coronal plane, radiologic outcomes showed no significant differences between the two techniques either. Conclusions The present study revealed that there were no significant differences in clinical or radiological outcomes between computer‐navigated TKA and conventional TKA. It remains unclear which TKA technique yields better results in terms of mid‐ to long‐term clinical and radiological outcomes. Level of evidence I.

Knee Prosthesis in the Computer Era

“…C onsistent with previous studies, recent reviews revealed that the superiority of the CAS-TKA technique over the conventional technique remains uncertain in the short and long term 65 . However, the efforts to better synchronize metal and plastic components to represent a normal knee continue to revealing minor but critical advances in precision.…”

Navigation und Robotik in der Knieendoprothetik

“…Lee et al [38] fanden hingegen in randomisierten kontrollierten Studien keinen signifikanten Unterschied bezüglich Ausreißern der Beinachse sowie der Femur-und Tibiakomponenten in der koronalen Ebene.…”

“…In den Verlaufskontrollen bis 5 Jahre gab es keinen Unterschied zwischen den beiden Gruppen, zwischen 5 und 8 Jahren konnten sie jedoch eine signifikante Verbesserung des WOMAC und des Function Score des KSS in der nav-TEP-Gruppe identifizieren [51]. Weitere Autoren kamen ebenfalls zum Schluss, dass beide Techniken auch noch nach 10 bis 12 Jahren gleiche Ergebnisse liefern [8,14,33,38,46,55].…”

“…Die Operationszeit ist auch bei der rob-TEP deutlich verlängert (25 min; [61]). Bezüglich Komplikationen gab es keinen Unterschied zwischen den beiden Gruppen [20,37,38], und in der rob-TEP-Gruppe war der intra-und postoperati-ve Blutverlust geringer (ca. 250 ml; [29,60,61]).…”

A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design

“…However, medium-term and long-term CAN-TKA clinical function outcomes and survivorship have been shown to be similar to conventional TKA despite improved radiographic alignment and fewer outliers achieved with navigation assistance. 23 – 26 …”