Computer Navigation-Assisted Knee Replacement Demonstrates Improved Outcome Compared with Conventional Knee Replacement at Mid-Term Follow-up: A Systematic Review and Meta-analysis

Abstract

The study is a systematic review and meta-analysis of prospective randomised control studies and prospective cohort studies of mid-term functional outcome of total knee replacement undertaken using imageless computer navigation compared with conventional instrumented total knee replacement. The literature search strategy included a search of the electronic databases, visual scanning of reference lists, hand searching of key journals and conference proceedings, and abstracts, citations, and trial registers. In total, 440 papers were retrieved after removal of duplicates, and with further screening, 11 papers were included in the systematic review and 6 papers were considered appropriate for meta-analysis. Analysis of the data showed evidence of a modest improvement in functional outcome at mid-term follow-up with use of imageless computer navigation assistance compared with conventional instrumented total knee replacement with a total score point estimate of 3.36 confidence interval (CI) (- 0.583, 7.298), objective score point estimate of 1.45 CI (0.11, 2.799), and functional score point estimate of 2.4, CI (- 1.174, 5.977). The predominant risk of bias was from random allocation and attrition. There is evidence of a modest improvement in functional outcome with the use of imageless computer navigation assistance compared with conventional instrumented total knee replacement at mid-term follow-up.

Keywords: Arthroplasty; Computer; Computer navigation; Imageless navigation; Knee; MeSH terms: arthroplasty; Navigation; Navigation-assisted knee; Replacement; Total knee replacement.

Fig. 1

Flowchart of the study selection process

Fig. 2

Point estimates with 50% and 95% confidence intervals for Total Score

Fig. 3

Point estimates with 50% and 95% confidence intervals for Objective Score

Fig. 4

Point estimates with 50% and 95% confidence intervals for Functional Score

Fig. 5

Funnel plot for Total Score Component of the Knee Society (KSS) Score

Fig. 6

Funnel plot for the Objective Score Component of the KSS Score

Fig. 7

Funnel plot for the Function Score Component of the KSS Score