The Cost-Effectiveness of Computer-Assisted Navigation in Total Knee Arthroplasty

Novak, Erik J.; Silverstein, Marc D.; Bozic, Kevin J.

doi:10.2106/00004623-200711000-00008

Cited by 93 publications

(22 citation statements)

References 43 publications

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“…This is consistent with most published controlled studies (Table VI). It should be emphasised that conventional systems have provided a largely acceptable mean post-operative HKA angle, [12][13][14][15][16][17][24][25][26][27][28][29][30][31][32][33][34][35][36] and it should be expected that PSCG would reduce the proportion of outliers, thereby enhancing precision more than accuracy. However, in our study there was no significant difference in the proportion of outliers for any measured angle, which refutes our hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 However, CAS in TKA has not been universally adopted to date owing to its cost, learning curve, additional surgical time and procedure-specific complications. [10][11][12] As an alternative, patient-specific cutting guides (PSCG) have been developed. These are custom-made blocks for the distal femur and proximal tibia and are designed from pre-operative three-dimensional (3D) CT or MRIbased reconstructions of the knee.…”

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confidence: 99%

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A comparison of patient-specific and conventional instrumentation for total knee arthroplasty

Abane

Anract

Boisgard

et al. 2015

The Bone & Joint Journal

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In this study we randomised 140 patients who were due to undergo primary total knee arthroplasty (TKA) to have the procedure performed using either patient-specific cutting guides (PSCG) or conventional instrumentation (CI). The primary outcome measure was the mechanical axis, as measured at three months on a standing long-leg radiograph by the hip-knee-ankle (HKA) angle. This was undertaken by an independent observer who was blinded to the instrumentation. Secondary outcome measures were component positioning, operating time, Knee Society and Oxford knee scores, blood loss and length of hospital stay. A total of 126 patients (67 in the CI group and 59 in the PSCG group) had complete clinical and radiological data. There were 88 females and 52 males with a mean age of 69.3 years (47 to 84) and a mean BMI of 28.6 kg/m(2) (20.2 to 40.8). The mean HKA angle was 178.9° (172.5 to 183.4) in the CI group and 178.2° (172.4 to 183.4) in the PSCG group (p = 0.34). Outliers were identified in 22 of 67 knees (32.8%) in the CI group and 19 of 59 knees (32.2%) in the PSCG group (p = 0.99). There was no significant difference in the clinical results (p = 0.95 and 0.59, respectively). Operating time, blood loss and length of hospital stay were not significantly reduced (p = 0.09, 0.58 and 0.50, respectively) when using PSCG. The use of PSCG in primary TKA did not reduce the proportion of outliers as measured by post-operative coronal alignment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A comparison of patient-specific and conventional instrumentation for total knee arthroplasty

Abane

Anract

Boisgard

et al. 2015

The Bone & Joint Journal

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“…4,6 Although computer-assisted TKR (CA-TKR) has the potential to improve alignment and reduce variation, 7 it introduces prolonged operating times, increased costs and complications arising from the guidance pins. 8,9,10 Patient-specific cutting guides (PSCGs), which use three-dimensional (3D) imaging to capture the true anatomy of an individual's knee, have been developed. Two guides are manufactured to match the patient's distal femur and proximal tibia.…”

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confidence: 99%

A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement

Chareancholvanich

Narkbunnam

Pornrattanamaneewong

2013

The Bone & Joint Journal

158

155

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Patient-specific cutting guides (PSCGs) are designed to improve the accuracy of alignment of total knee replacement (TKR). We compared the accuracy of limb alignment and component positioning after TKR performed using PSCGs or conventional instrumentation. A total of 80 patients were randomised to undergo TKR with either of the different forms of instrumentation, and radiological outcomes and peri-operative factors such as operating time were assessed. No significant difference was observed between the groups in terms of tibiofemoral angle or femoral component alignment. Although the tibial component in the PSCGs group was measurably closer to neutral alignment than in the conventional group, the size of the difference was very small (89.8° (sd 1.2) vs 90.5° (sd 1.6); p = 0.030). This new technology slightly shortened the bone-cutting time by a mean of 3.6 minutes (p < 0.001) and the operating time by a mean 5.1 minutes (p = 0.019), without tangible differences in post-operative blood loss (p = 0.528) or need for blood transfusion (p = 0.789). This study demonstrated that both PSCGs and conventional instrumentation restore limb alignment and place the components with the similar accuracy. The minimal advantages of PSCGs in terms of consistency of alignment or operative time are unlikely to be clinically relevant.

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“…Therefore improved alignment of the components relative to the mechanical axis of the limb may increase prosthesis longevity, reduce revision rates and consequently prove a more cost effective method of arthroplasty [14,15]. In addition, by avoiding instrumentation of the intramedullary canal the significant blood loss associated with TKR [16][17][18] can be minimised and micro-embolic phenomena such as in Deep Venous Thrombosis and Pulmonary Embolism can also be reduced [19,20].…”

Section: Introductionmentioning

confidence: 99%

Computer assisted versus conventional total knee replacement: A comparison of tourniquet time, blood loss and length of stay

et al. 2012

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The Cost-Effectiveness of Computer-Assisted Navigation in Total Knee Arthroplasty

Abstract: Background: Total knee arthroplasty is one of the most clinically successful and cost-effective interventions in med-

Cited by 93 publications

References 43 publications

A comparison of patient-specific and conventional instrumentation for total knee arthroplasty

A comparison of patient-specific and conventional instrumentation for total knee arthroplasty

A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement

Computer assisted versus conventional total knee replacement: A comparison of tourniquet time, blood loss and length of stay

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