Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery.

Computer-assisted surgery (CAS) has been advocated as a means to improve limb and prosthesis alignment and assist in ligament balancing in total knee arthroplasty (TKA). Thus, we sought to examine alignment outcomes in CAS vs conventional TKA. A systematic review of literature from 1990 to 2007 was performed. Direct comparison of alignment outcomes was performed using random effects meta-analyses. Twenty-nine studies of CAS vs conventional TKA were identified, and included mechanical axis malalignment of greater than 3 degrees occurred in 9.0% of CAS vs 31.8% of conventional TKA patients. The risk of greater than 3 degrees malalignment was significantly less with CAS than conventional techniques for mechanical axis and frontal plane femoral and tibial component alignment. Tibial and femoral slope both showed statistical significance in favor of CAS at greater than 2 degrees malalignment. Meta-analysis of alignment outcomes for CAS vs conventional TKA indicates significant improvement in component orientation and mechanical axis when CAS is used.

[1]  Chih-Wei Chang,et al.  Kinematic navigation in total knee replacement--experience from the first 50 cases. , 2006, Journal of the Formosan Medical Association = Taiwan yi zhi.

[2]  P. Nicolai,et al.  The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. , 2001, The Journal of arthroplasty.

[3]  M. Kurosaka,et al.  Prosthetic alignment and sizing in computer-assisted total knee arthroplasty , 2004, International Orthopaedics.

[4]  N. Confalonieri,et al.  Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. , 2005, Acta orthopaedica Belgica.

[5]  B. Philipps,et al.  Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis , 2002, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  R A Berger,et al.  Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. , 1993, Clinical orthopaedics and related research.

[7]  Steffen Kohler,et al.  Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. , 2005, The Journal of arthroplasty.

[8]  P Cinquin,et al.  [Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study]. , 2001, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[9]  M Tingart,et al.  [Navigated implantation of total knee endoprostheses in secondary knee osteoarthritis of rheumatoid arthritis patients as compared to conventional technique]. , 2004, Zeitschrift fur Rheumatologie.

[10]  Markus Tingart,et al.  CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. , 2004, Orthopedics.

[11]  R. Laskin.  Instrumentation pitfalls: you just can't go on autopilot! , 2002, The Journal of arthroplasty.

[12]  Pak Lin Chin,et al.  Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. , 2005, The Journal of arthroplasty.

[13]  D. Wyss,et al.  Is Restricted Femoral Navigation Sufficient for Accuracy of Total Knee Arthroplasty? , 2006, Clinical orthopaedics and related research.

[14]  S. Stulberg,et al.  Computer-assisted total knee replacement arthroplasty , 2000 .

[15]  Richard L Wixson,et al.  Computer assisted navigation in total knee arthroplasty: improved coronal alignment. , 2005, The Journal of arthroplasty.

[16]  Dominique Scipioni,et al.  Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases. , 2005, Acta orthopaedica Belgica.

[17]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[18]  M. Janeček,et al.  Total knee arthroplasty implanted with and without kinematic navigation , 2003, International Orthopaedics.

[19]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[20]  D. Cook,et al.  Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions , 1997, Annals of Internal Medicine.

[21]  Jan Victor,et al.  Image-Based Computer-Assisted Total Knee Arthroplasty Leads to Lower Variability in Coronal Alignment , 2004, Clinical orthopaedics and related research.

[22]  K. Buehler,et al.  Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. , 2005, The Journal of arthroplasty.

[23]  J O Galante,et al.  Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. , 1994, Clinical orthopaedics and related research.

[24]  D. Banzer,et al.  Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. , 2003, The Journal of bone and joint surgery. British volume.

[25]  U. Grittner,et al.  Computerised and technical navigation in total knee-arthroplasty , 2005, Journal of Orthopaedics and Traumatology.

[26]  M. Tingart,et al.  Navigation in total-knee arthroplastyCT-based implantation compared with the conventional technique , 2004, Acta orthopaedica Scandinavica.

[27]  J. Grifka,et al.  Der navigationsgestützte bicondyläre Oberflächenersatz bei der sekundären Gonarthrose des RA-Patienten im Vergleich zur konventionellen Implantationstechnik , 2004, Zeitschrift für Rheumatologie.

[28]  R. Barrack,et al.  Component Rotation and Anterior Knee Pain After Total Knee Arthroplasty , 2001, Clinical orthopaedics and related research.

[29]  C. Boéri,et al.  Computer-assisted implantation of total knee prostheses: a case-control comparative study with classical instrumentation. , 2001, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[30]  F. Daubresse,et al.  Total knee arthroplasty with conventional or navigated technique: comparison of the learning curves in a community hospital. , 2005, Acta orthopaedica Belgica.

[31]  D. Zurakowski,et al.  Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. , 2004, The Journal of bone and joint surgery. British volume.

[32]  B. Hanson,et al.  Navigated total knee replacement. A meta-analysis. , 2007, The Journal of bone and joint surgery. American volume.

[33]  Martin Stockheim,et al.  Computer-Assisted Navigation Increases Precision of Component Placement in Total Knee Arthroplasty , 2005, Clinical orthopaedics and related research.

[34]  M. Ritter,et al.  Postoperative alignment of total knee replacement. Its effect on survival. , 1994, Clinical orthopaedics and related research.

[35]  Wolfhart Puhl,et al.  Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. , 2005, The Journal of arthroplasty.

[36]  U Holz,et al.  [CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study]. , 2003, Der Unfallchirurg.

[37]  S. Delp,et al.  Computer assisted knee replacement. , 1998, Clinical orthopaedics and related research.

[38]  Cyril Boeri,et al.  Low reproducibility of the intra–operative measurement of the transepicondylar axis during total knee replacement , 2004, Acta orthopaedica Scandinavica.

[39]  Peter Loan,et al.  Computer-Assisted Navigation in Total Knee Replacement: Results of an Initial Experience in Thirty-five Patients , 2002, The Journal of bone and joint surgery. American volume.

[40]  W. Breidahl,et al.  Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. , 2004, The Journal of bone and joint surgery. British volume.

[41]  M. Tingart,et al.  Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty , 2004, International Orthopaedics.