Computer-Assisted Navigation in Knee Arthroplasty: A Critical Appraisal

Abstract

The purpose of this review was to appraise the use of computer-assisted navigation in total knee arthroplasty and to assess whether this technology has improved clinical outcomes. Studies were identified through searches in MEDLINE, Embase, and PubMed. Numerous studies have shown improved leg and component alignment using navigation systems. However, the better alignment achieved in navigated knee arthroplasty has not been shown to lead to better clinical outcomes. Navigated knee arthroplasty had lower calculated blood loss and lower incidence of fat embolism compared with conventional knee arthroplasty using intramedullary jigs. It may be most valued when dealing with complex knee deformities, revision surgery, or minimally invasive surgery. Navigated knee arthroplasty, however, is only cost-effective in centers with a high volume of joint replacements. Overall, computer-assisted navigated knee arthroplasty provides some advantages over conventional surgery, but its clinical benefits to date are unclear and remain to be defined on a larger scale.

Keywords

navigation - computer-assisted navigation - knee arthroplasty - outcome - knee replacement

• References

• 1 Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 1988; (232) 168-173
• 2 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86-A (5) 963-974
• 3 Gill GS, Joshi AB, Mills DM. Total condylar knee arthroplasty. 16- to 21-year results. Clin Orthop Relat Res 1999; (367) 210-215
• 4 Ranawat CS, Flynn Jr WF, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop Relat Res 1993; (286) 94-102
• 5 Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res 1997; (345) 79-86
• 6 Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997. Acta Orthop Scand 2001; 72 (5) 503-513
• 7 National Joint Registry for England and Wales – 8th Annual Report 2011 2011. Available at http://www.njrcentre.org.uk/njrcentre/portals/0/documents/NJR%208th%20annual%20report%202011.Pdf
• 8 Coyte PC, Hawker G, Croxford R, Wright JG. Rates of revision knee replacement in Ontario, Canada. J Bone Joint Surg Am 1999; 81 (6) 773-782
• 9 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
• 10 Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 1988; (226) 49-64
• 11 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (1) 77-79
• 12 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
• 13 Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 1993; (286) 40-47
• 14 Figgie III HE, Goldberg VM, Heiple KG, Moller III HS, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 1986; 68 (7) 1035-1040
• 15 Piazza SJ, Delp SL, Stulberg SD, Stern SH. Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study. J Orthop Res 1998; 16 (2) 264-270
• 16 Tew M, Waugh W. Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 1985; 67 (4) 551-556
• 17 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (5) 709-714
• 18 Jeffcote B, Shakespeare D. Varus/valgus alignment of the tibial component in total knee arthroplasty. Knee 2003; 10 (3) 243-247
• 19 Petersen TL, Engh GA. Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 1988; 3 (1) 67-72
• 20 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 (5) 635-640
• 21 Teter KE, Bregman D, Colwell Jr CW. Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 106-110
• 22 Teter KE, Bregman D, Colwell Jr CW. The efficacy of intramedullary femoral alignment in total knee replacement. Clin Orthop Relat Res 1995; (321) 117-121
• 23 Bäthis 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 (2) 87-90
• 24 Bäthis H, Perlick L, Tingart M, Lüring C, Grifka J. CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. Orthopedics 2004; 27 (5) 476-480
• 25 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 (4) 464-470
• 26 Jenny JY, Boeri C. Computer-assisted implantation of total knee prostheses: a case-control comparative study with classical instrumentation. Comput Aided Surg 2001; 6 (4) 217-220
• 27 Nishihara S, Sugano N, Ikai M , et al. Accuracy evaluation of a shape-based registration method for a computer navigation system for total knee arthroplasty. J Knee Surg 2003; 16 (2) 98-105
• 28 Stindel E, Briard JL, Merloz P , et al. Bone morphing: 3D morphological data for total knee arthroplasty. Comput Aided Surg 2002; 7 (3) 156-168
• 29 Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res 1998; (354) 49-56
• 30 DiGioia III AM, Jaramaz B, Colgan BD. Computer assisted orthopedic surgery. Image guided and robotic assistive technologies. Clin Orthop Relat Res 1998; 8-16
• 31 Krackow KA, Bayers-Thering M, Phillips MJ, Bayers-Thering M, Mihalko WM. A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA. Orthopedics 1999; 22 (7) 698-702
• 32 Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 2003; 85 (6) 830-835
• 33 Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 2002; 84-A (Suppl. 02) 90-98
• 34 Hart R, Janecek M, Chaker A, Bucek P. Total knee arthroplasty implanted with and without kinematic navigation. Int Orthop 2003; 27 (6) 366-369
• 35 Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 2004; 86 (5) 682-687
• 36 Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 2004; 86 (3) 372-377
• 37 Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 2005; 20 (3) 282-288
• 38 Kahler DM. Image guidance: fluoroscopic navigation. Clin Orthop Relat Res 2004; (421) 70-76
• 39 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
• 40 Molfetta L, Caldo D. Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee 2008; 15 (2) 75-79
• 41 Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 2004; 86 (6) 818-823
• 42 Manzotti A, Confalonieri N, Pullen C. Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study. Int Orthop 2007; 31 (3) 315-319
• 43 Maculé-Beneyto F, Hernández-Vaquero D, Segur-Vilalta JM , et al. Navigation in total knee arthroplasty. A multicenter study. Int Orthop 2006; 30 (6) 536-540
• 44 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 (5) 1255-1261
• 45 Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 2007; 457: 156-162
• 46 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 (4) 560-569
• 47 Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ. Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 2007; 89 (4) 477-480
• 48 Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81 (1) 2-10
• 49 Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 2005; 87 (11) 1480-1482
• 50 Church JS, Scadden JE, Gupta RR, Cokis C, Williams KA, Janes GC. Embolic phenomena during computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 2007; 89 (4) 481-485
• 51 Kalairajah Y, Cossey AJ, Verrall GM, Ludbrook G, Spriggins AJ. Are systemic emboli reduced in computer-assisted knee surgery?: a prospective, randomised, clinical trial. J Bone Joint Surg Br 2006; 88 (2) 198-202
• 52 Bauwens K, Matthes G, Wich M , et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89 (2) 261-269
• 53 Sculpher M, Drummond M, Buxton M. The iterative use of economic evaluation as part of the process of health technology assessment. J Health Serv Res Policy 1997; 2 (1) 26-30
• 54 Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005; 20 (7, Suppl 3) 132-138
• 55 Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 2005; (433) 152-159
• 56 Chin PL, Yang KY, Yeo SJ, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 2005; 20 (5) 618-626
• 57 Dong H, Buxton M. Early assessment of the likely cost-effectiveness of a new technology: a Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement. Int J Technol Assess Health Care 2006; 22 (2) 191-202
• 58 Novak EJ, Silverstein MD, Bozic KJ. The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 2007; 89 (11) 2389-2397
• 59 Slover JD, Tosteson AN, Bozic KJ, Rubash HE, Malchau H. Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am 2008; 90 (7) 1492-1500
• 60 The Patient Protection and Affordable Care Act of 2010. Public Law, 111–148. 2010.
• 61 Katz JN, Mahomed NN, Baron JA , et al. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum 2007; 56 (2) 568-574
• 62 Soohoo NF, Zingmond DS, Lieberman JR, Ko CY. Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes?. J Arthroplasty 2006; 21 (2) 199-205
• 63 Saragaglia D, Chaussard C, Rubens-Duval B. Navigation as a predictor of soft tissue release during 90 cases of computer-assisted total knee arthroplasty. Orthopedics 2006; 29 (10) (, Suppl) S137-S138