Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review

Abstract

Background: Navigated total knee arthroplasty (TKA) may improve coronal alignment outliers; however, it is unclear whether navigated TKA improves the long-term clinical results of TKA.

Questions/purposes: Does the literature contain evidence of better long-term function and lower revision rates with navigated TKA compared with conventional TKA?

Methods: A systematic literature review was conducted of navigated TKA reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction, component rotation, anteroposterior and mediolateral stability, complications, and longer-term reports.

Results: Coronal plane alignment is improved with navigated TKA with fewer radiographic outliers. We found limited evidence of improvements in any other variable, and function was not improved. The duration of surgery is increased and there are unique complications related to navigated TKA. The long-term benefits of additional increase in accuracy of alignment are not supported by any current evidence.

Conclusions: The findings in reports of navigated TKA should be interpreted with caution. There are few short- and medium- and no long-term studies demonstrating improved clinical outcomes using navigated TKA. Despite substantial research, contradictory findings coupled with reservations about the cost and efficacy of the technology have contributed to the failure of computer navigation to become the accepted standard in TKA. Longer-term studies demonstrating improved function, lower revision rates, and acceptable costs are required before navigated TKA may be widely adopted. In the future, with improvements in study design, methodology, imaging, navigation technology, newer functional outcome tools, and longer-term followup studies, we suspect that navigated TKA may demonstrate yet unrecognized benefits.

Fig. 1A–G

A 65-year-old woman presents at 6 months postoperatively with distal thigh pain; routine AP (A) and lateral (B) radiographs were performed. Longer leg femur films (C–D) demonstrate the distal pin sites with periosteal bone reaction. Two weeks later the patient presented with a transverse distal femur fracture (E) requiring retrograde nailing (F–G).