Clinical and radiographic outcomes of Image-Based Computer-Assisted Total Knee Arthroplasty: An Evidence-based Evaluation

Abstract

Conventional instrumentation systems have limited accuracy in determining the crucial landmarks needed for alignment in total knee arthroplasty (TKA). Given this, the image-based navigation system was introduced to improve the accuracy of implantation of components into the femur and tibia. PubMed, EMBASE, Web of Science, and Evidence-Based Medicine databases were electronically searched to identify eligible studies published until October 2008. A systematic review and meta-analysis of 6 randomized/quasi-randomized controlled trials that compared image-based navigation and conventional techniques was conducted. The operative time was longer in the navigation group in 3 studies. Moreover, there was a higher rate of achieving mechanical leg axis within the range of 3° deviation in patients undergoing navigated TKA. However, all studies between the 2 groups were similar in range of motion, knee scores, and postoperative complication rates at the last follow-up. Overall, these short-term follow-up trials show that there were similar early clinical outcomes between image-based navigation and conventional techniques.

Keywords

meta analysis systematic review computer-assisted surgery navigation total knee arthroplasty (TKA)

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References

Lombardi AV Jr , Berend KR , Walter CA , Aziz-Jacobo J. , Cheney NA

Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?

Clin Orthop Relat Res. 2009;467:1450-1457.

Horwitz MD , Awan S. , Chatoo MB , Stott DJ , Powles DP An 8- to 10-year review of the Rotaglide total knee replacement. Int Orthop. 2009;33:111-115.

Parsch D. , Krüger M. , Moser MT , Geiger F. Follow-up of 11-16 years after modular fixed-bearing TKA. Int Orthop. 2009;33:431-435.

Ang DC , Tahir N. , Hanif H. , Tong Y. , Ibrahim SA African Americans and Whites are equally appropriate to be considered for total joint arthroplasty. J Rheumatol. 2009 ;36:1971-1976.

Kashyap SN , Van Ommeren JW , Shankar S. Minimally invasive surgical technique in total knee arthroplasty: a learning curve. Surg Innov. 2009;16:55-62.

Erak S. , Rajgopal V. , Macdonald SJ , McCalden RW , Bourne RB Ten-year results of an inset biconvex patella prosthesis in primary knee arthroplasty . Clin Orthop Relat Res. 2009;467:1781-1792.

Berger RA , Crossett LS , Jacobs JJ , Rubash HE Malrotation causing patellofemoral complications after total knee arthroplasty . Clin Orthop Relat Res. 1998 ;356:144-153.

Jeffery RS , Morris RW , Denham RA Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709-714.

Wasielewski RC , Galante JO , Leighty RM , Natarajan RN , Rosenberg AG Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res. 1994;299:31-43.

10.

Czurda T. , Fennema P. , Baumgartner M. , Ritschl P. The association between component malalignment and postoperative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc. 2010;18:863-869.

11.

Mahaluxmivala J. , Bankes MJ , Nicolai P. , Aldam CH , Allen PW The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty . 2001;16:635-640.

12.

Petersen TL , Engh GA Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty. 1988;3:67-72.

13.

Hernández-Vaquero D. , Suarez-Vazquez A. , Sandoval-Garcia MA , Noriega-Fernandez A. Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res . 2010;468:1237-1241.

14.

Stiehl JB Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation. Int Orthop. 2009 ;33:679-685.

15.

van Strien T. , van der Linden-van der Zwaag E. , Kaptein B. , van Erkel A. , Valstar E. , Nelissen R. Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component. Int Orthop. 2009;33:1255-1261.

16.

Dattani R. , Patnaik S. , Kantak A. , Tselentakis G. Navigation knee replacement. Int Orthop. 2009 ;33:7-10.

17.

Kamat YD , Aurakzai KM , Adhikari AR , Matthews D. , Kalairajah Y. , Field RE Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop. 2009;33:1567-1570

18.

Minoda Y. , Kobayashi A. , Iwaki H. , Ohashi H. , Takaoka K. TKA sagittal alignment with navigation systems and conventional techniques vary only a few degrees. Clin Orthop Relat Res. 2009;467:1000-1006.

19.

Lubicky JP Levels of evidence. J Bone Joint Surg Br. 2006;88:1264-1265.

20.

Petrisor BA , Keating J. , Schemitsch E. Grading the evidence: levels of evidence and grades of recommendation. Injury. 2006;37:321-327.

21.

Obremskey WT , Pappas N. , Attallah-Wasif E. , Tornetta P. 3rd , Bhandari M. Level of evidence in orthopaedic journals. J Bone Joint Surg Am. 2005;87:2632-2638.

22.

Böhling U. , Schamberger H. , Grittner U. , Scholz J. Computerised and technical navigation in total knee-arthroplasty. J Orthopaed Traumatol. 2005;6:69-75.

23.

Mizu-uchi H. , Matsuda S. , Miura H. , Okazaki K. , Akasaki Y. , Iwamoto Y. The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br. 2008;90:1025-1031.

24.

Oberst M. , Bertsch C. , Würstlin S. , Holz U. CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study [in German]. Unfallchirurg. 2003;106:941-948.

25.

Victor J. , Hoste D. Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res. 2004;428:131-139.

26.

Perlick L. , Bäthis H. , Tingart M. , Perlick C. , Grifka J. Navigation in total-knee arthroplasty: CT-based implantation compared with the conventional technique. Acta Orthop Scand. 2004;75:464-470.

27.

Zumstein MA , Frauchiger L. , Wyss D. , Hess R. , Ballmer PM Is restricted femoral navigation sufficient for accuracy of total knee arthroplasty? Clin Orthop Relat Res. 2006;451:80-86.

28.

Mullaji A. , Shetty GM Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity. J Arthroplasty. 2009;24:1164-1169.

29.

Ritter MA , Faris PM , Keating EM , Meding JB Postoperative alignment of total knee replacement. Its effect on survival . Clin Orthop Relat Res. 1994;299:153-156.

30.

Choong PF , Dowsey MM , Stoney JD Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty . J Arthroplasty. 2009;24:560-569.

31.

Longstaff LM , Sloan K. , Stamp N. , Scaddan M. , Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function . J Arthroplasty . 2009;24: 570-578.

32.

Mason JB , Fehring TK , Estok R. , Banel D. , Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007 ;22:1097-1106.

33.

Bauwens K. , Matthes G. , Wich M. , Gebhard F. , Hanson B. , Ekkernkamp A. , Stengel D. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007;89: 261-269.

34.

Martin A. , von Strempel A. Two-year outcomes of computed tomography-based and computed tomography free navigation for total knee arthroplasties. Clin Orthop Relat Res. 2006;449:275-282.

35.

Bathis H. , Perlick L. , Tingart M. , Lüring C. , Perlick C. , Grifka J. Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop. 2004;28:87-90.