Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2  = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.RésuméLa navigation dans la prothèse totale du genou permet d’avoir une amélioration de l’alignement articulaire. Nous avons comparé le devenir d’une prothèse totale du genou naviguée, ou traitée par voie conventionnelle, avec une analyse radiologique des genoux présentant une déviation externe en valgus. Nous avons analysé 637 prothèses totales du genou, réalisées par le même chirurgien sur 5 ans et divisées en deux groupes: le groupe 1 STA avec une instrumentation standard et le groupe 2 CAS avec navigation. Il n’y a pas de différence significative au niveau des scores d’Oxford (OKS) dans les deux groupes sur une période de 1 à 5 ans. Cependant, les genoux présentant un défaut d’axe post-opératoire ont un résultat OKS dégradé au bout de la troisième année. A moyen terme, il n’y a pas de différence sur le devenir clinique mais le groupe 1 a néanmoins une proportion beaucoup plus importante de genoux présentant une déviation axiale ce qui peut influer, de façon négative sur le score OKS à long terme.

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