Influence of computer navigation on TKA revision rates

Abstract

Purpose: We performed this study to determine whether the use of imageless navigation reduces revision rates after total knee arthroplasty (TKA).

Methods: Data of 1,121 consecutive primary TKA with a follow-up of one to six years were retrospectively analysed. Following the conversion of the standard technique from conventional to navigated procedures, these data included the last 342 conventional and first 779 navigated procedures performed in our clinic. Demographic and perioperative covariates were recorded. All patients were asked by post to report instances of revisions.

Results: Data of 1,054 patients (94 %) were complete. Mean follow-up was 3.9 years for conventional and 2.4 years for navigated operations. Cumulative revision rate averaged 4.7 % for conventional and 2.3 % for navigated procedures. Cox's proportional hazard model was used to assess the effect of covariates on survival, resulting in significantly lower revision rates for older patients (p < 0.001) and for the navigated technique (p = 0.012). The reduced revision rate for navigated operations was mainly caused by a significantly reduced rate of aseptic implant loosening (1.9 % vs. 0.1 %, p = 0.024).

Conclusions: Our study showed lower revision rates when computer navigation was used. However, due to the retrospective uncontrolled design, further prospective trials will be necessary to further evaluate this effect.

Fig. 1

Patient selection for the study

Fig. 2

Cumulative revision rate for all patients (blue line)

Fig. 3

Cumulative revision rates for patients younger than 60 years (blue line), from 61 to 80 years (green line), and older than 80 years (grey line). Higher revision rates were identified in younger patients

Fig. 4

Navigated alignment procedure (green line) reduced the cumulative revision rate in comparison with conventionally aligned prostheses (blue line)