Computer Navigation for Total Knee Arthroplasty Reduces Revision Rate for Patients Less Than Sixty-five Years of Age (original) (raw)
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Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?
International …, 2009
Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2 = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.
Postoperative morbidity and mortality following total knee arthroplasty with computer navigation
The Knee, 2010
The incidence of postoperative complications following computer navigated total knee arthroplasty is unknown. There is no published evidence to support decreased morbidity compared to standard conventional technique. The Nationwide Inpatient Sample database was used to identify 101,596 patients who underwent total knee arthroplasty in 2005. Of these patients, 1156 were coded as having a computerassisted procedure. Bivariate analysis and regression modeling were used to compare postoperative inhospital outcomes between the computer-assisted and non-navigated cohorts. We found no differences in postoperative mortality or complications for the majority of our measured outcomes. Under multivariate regression analysis, computer navigation was associated with a lower rate of postoperative cardiac complications (odds ratio 0.40, p = 0.042), a shorter length of stay, and a trend towards fewer hematomas. Further clinical study is required to examine the possible association of computer navigation with postoperative morbidity following knee arthroplasty.
The Journal of Bone and Joint Surgery. British volume, 2012
The aim of this prospective single-centre study was to assess the difference in clinical outcome between total knee replacement (TKR) using computerised navigation and that of conventional TKR. We hypothesised that navigation would give a better result at every stage within the first five years. A total of 195 patients (195 knees) with a mean age of 70.0 years (39 to 89) were allocated alternately into two treatment groups, which used either conventional instrumentation (group A, 97 knees) or a navigation system (group B, 98 knees). After five years, complete clinical scores were available for 121 patients (62%). A total of 18 patients were lost to follow-up. Compared with conventional surgery, navigated TKR resulted in a better mean Knee Society score (p = 0.008). The difference in mean Knee Society scores over time between the two groups was not constant (p = 0.006), which suggests that these groups differed in their response to surgery with time. No significant difference in the ...
Computer navigation and total knee arthroplasty
Orthopedics, 2014
Research has added evidence in favor of computer-navigated techniques over conventional surgery for total knee arthroplasty (TKA). The goal of the current meta-analysis was to compare the outcome of outliers in mechanical axis and postoperative complications in patients undergoing conventional vs computer-navigated techniques for TKA. English literature searches were performed in PubMed, EMBASE, Web of Science, and the Cochrane Library for studies published between January 2002 and August 2012. Randomized, controlled trials comparing computer navigation with conventional surgery for the measurement of mechanical axes in patients with primary osteoarthritis were considered eligible. Fifteen trials were eligible for inclusion. The baseline demographics of 2089 patients (computer-navigated=1111; conventional=978) were well matched. Publication bias was eliminated using the funnel plot. A mechanical axis of more than 30° was considered to be malalignment and an outlier in limb alignment...
Computer-Assisted Navigation Software Advancements Improve the Accuracy of Total Knee Arthroplasty
The Journal of Arthroplasty, 2011
The purpose of this study was to evaluate the effectiveness of software advancements in improving total knee component positioning and limb alignment when using computer-aided navigation. A single total joint fellowship-trained surgeon performed unilateral total knee arthroplasty on 315 patients using conventional techniques or with assistance from computer navigation software. Preoperative and postoperative x-ray measurements were taken and analyzed. Our previous work demonstrated a statistically significant improvement (P b .02) in limb alignment (±3°of biomechanical neutral) when using version 2.0 software (93%) when compared with conventional techniques (82%). Further improvement was demonstrated with the version 3.1 software (99%, P b .03). The tourniquet times were recorded for each group and showed a significant improvement with the 3.1 software (conventional = 74 minutes, 2.0 navigation = 90 minutes, and 3.1 navigation = 73 minutes). The Stryker 2.0 software (Stryker Orthopedics, Mahwah, NJ) tourniquet time was statistically significantly longer than either the conventional or the 3.1 group (P b .001). Outcomes-based studies will be required to see if these factors will lead to improved patient function and/or prolonged prosthetic survival rates.
Indian Journal of Orthopaedics
Purpose The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. Methods We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ±...
The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty
2010
We reviewed the outcomes of 30 consecutive primary unicompartmental knee arthroplasties (UKA) performed by a single surgeon for medial compartmental osteoarthritis. Fifteen Allegretto knees were implanted without computer navigation and 15 EIUS knees were implanted with navigation. We compared the survivorship, radiological and clinical outcomes of the two groups at an average of 8.9 years and 6.9 years respectively. The patients were assessed clinically using the Oxford Knee Score (OKS) and radiologically using long-leg weightbearing films and non-weightbearing computed tomography alignment measurements. The overall survivorship was 86.7% at 9 years. A higher proportion of navigated knees were well aligned with a more reproducible position and malaligned knees tended to have a less favourable OKS. However, we found no statistically significant difference in survivorship, clinical outcome and radiological alignment between the two groups.
"Given the importance of component position in knee function following total knee arthroplasty (TKA), computer-assisted navigation has emerged as a tool for reducing the occurrence of significant malalignment. Intraoperative navigation data was collected prospectively for 134 knees undergoing cemented, posterior stabilized TKA. Partial least squares regression analysis was used to test the association between patient demographics and intraoperative data collected with a computer assisted navigation system (coronal alignment, ligament balance, range of motion, external tibio-femoral rotation ) with one year outcomes (SF36, Oxford Knee Score, range of motion). Age at surgery displayed the largest coefficients of any other predictor. In contrast, navigation coefficients were variable in the strength and direction of their association with the outcomes variable. Static knee alignment data obtained intraoperatively have limited capacity to explain the variance in functional outcome at one-year. While alignment and component position can be precisely measured intraoperatively, intrinsic patient factors remain dominant in determining outcome."
Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases
Revista Brasileira de Ortopedia (English Edition), 2014
Objective: to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. Method: a total of 196 patients who underwent total knee arthroplasty with computerassisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months. Results: in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3 • of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. Conclusion: the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.