Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2013

01-01-2013 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review

Authors: R. Stephen J. Burnett, MD, FRCSCC, Robert L. Barrack, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2013

Login to get access

Abstract

Background

Navigated total knee arthroplasty (TKA) may improve coronal alignment outliers; however, it is unclear whether navigated TKA improves the long-term clinical results of TKA.

Questions/Purposes

Does the literature contain evidence of better long-term function and lower revision rates with navigated TKA compared with conventional TKA?

Methods

A systematic literature review was conducted of navigated TKA reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction, component rotation, anteroposterior and mediolateral stability, complications, and longer-term reports.

Results

Coronal plane alignment is improved with navigated TKA with fewer radiographic outliers. We found limited evidence of improvements in any other variable, and function was not improved. The duration of surgery is increased and there are unique complications related to navigated TKA. The long-term benefits of additional increase in accuracy of alignment are not supported by any current evidence.

Conclusions

The findings in reports of navigated TKA should be interpreted with caution. There are few short- and medium- and no long-term studies demonstrating improved clinical outcomes using navigated TKA. Despite substantial research, contradictory findings coupled with reservations about the cost and efficacy of the technology have contributed to the failure of computer navigation to become the accepted standard in TKA. Longer-term studies demonstrating improved function, lower revision rates, and acceptable costs are required before navigated TKA may be widely adopted. In the future, with improvements in study design, methodology, imaging, navigation technology, newer functional outcome tools, and longer-term followup studies, we suspect that navigated TKA may demonstrate yet unrecognized benefits.
Literature
1.
Alan RK, Shin MS, Tria AJ Jr. Initial experience with electromagnetic navigation in total knee arthroplasty: a radiographic comparative study. J Knee Surg. 2007;20:152–157.PubMed
2.
Australian Orthopaedic Association National Joint Replacement Registry. Computer Assisted Surgery in Primary Total Knee Replacement Between 2006 and 2008. Adelaide, Australia: AOA NJRR; 2010.
3.
Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PF. Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Joint Surg Br. 2011;93:1223–1231.PubMedCrossRef
4.
Barrack RL, Barnes CL, Burnett RS, Miller D, Clohisy JC, Maloney WJ. Minimal incision surgery as a risk factor for early failure of total knee arthroplasty. J Arthroplasty. 2009;24:489–498.PubMedCrossRef
5.
Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res. 2001;392:46–55.PubMedCrossRef
6.
Barrett WP, Mason JB, Moskal JT, Dalury DF, Oliashirazi A, Fisher DA. Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. J Arthroplasty. 2011;26:1273–1284.e1271.
7.
Bathis H, Perlick L, Tingart M, Luring C, Grifka J. CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. Orthopedics. 2004;27:476–480.PubMed
8.
Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J. Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop. 2004;28:87–90.PubMedCrossRef
9.
Bathis H, Perlick L, Tingart M, Luring 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;86:682–687.PubMedCrossRef
10.
Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007;89:261–269.PubMedCrossRef
11.
Bejek Z, Solyom L, Szendroi M. Experiences with computer navigated total knee arthroplasty. Int Orthop. 2007;31:617–622.PubMedCrossRef
12.
Beldame J, Boisrenoult P, Beaufils P. Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res. 2010;96:249–255.PubMedCrossRef
13.
Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res. 2012;470:45–53.PubMedCrossRef
14.
Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;428:26–34.PubMedCrossRef
15.
Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998;356:144–153.PubMedCrossRef
16.
Blakeney WG, Khan RJ, Wall SJ. Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93:1377–1384.PubMedCrossRef
17.
Bohling U, Schamberger H, Grittner U, Scholz J. Computerised and technical navigation in total knee arthroplasty. J Orthop Traumatol. 2005;6:69–75.CrossRef
18.
Bolognesi M, Hofmann A. Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res. 2005;440:162–169.PubMedCrossRef
19.
Bonutti P, Dethmers D, Stiehl JB. Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res. 2008;466:1499–1502.PubMedCrossRef
20.
Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA. Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res. 2008;466:2756–2762.PubMedCrossRef
21.
Bonutti PM, Dethmers DA, McGrath MS, Ulrich SD, Mont MA. Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res. 2008;466:2730–2735.PubMedCrossRef
22.
Bottros J, Klika AK, Lee HH, Polousky J, Barsoum WK. The use of navigation in total knee arthroplasty for patients with extra-articular deformity. J Arthroplasty. 2008;23:74–78.PubMedCrossRef
23.
Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J. Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop. 2011;35:331–339.PubMedCrossRef
24.
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;86:372–377.PubMedCrossRef
25.
Cheng T, Zhang G, Zhang X. Clinical and radiographic outcomes of image-based computer-assisted total knee arthroplasty: an evidence-based evaluation. Surg Innov. 2011;18:15–20.PubMedCrossRef
26.
Cheung KW, Chiu KH. Imageless computer navigation in total knee arthroplasty. Hong Kong Med J. 2009;15:353–358.PubMed
27.
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;20:618–626.PubMedCrossRef
28.
Choi WC, Lee S, An JH, Kim D, Seong SC, Lee MC. Plain radiograph fails to reflect the alignment and advantages of navigation in total knee arthroplasty. J Arthroplasty. 2011;26:756–764.PubMedCrossRef
29.
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;24:560–569.PubMedCrossRef
30.
Chung BJ, Kang YG, Chang CB, Kim SJ, Kim TK. Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res. 2009;467:2403–2413.PubMedCrossRef
31.
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;89:481–485.PubMedCrossRef
32.
Czurda T, Fennema P, Baumgartner M, Ritschl P. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc. 2010;18:863–869.PubMedCrossRef
33.
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;20:282–288.PubMedCrossRef
34.
Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res. 1998;354:49–56.PubMedCrossRef
35.
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;22:191–202.PubMedCrossRef
36.
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.PubMed
37.
Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, 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;68:1035–1040.PubMed
38.
Gothesen O. Norwegian register shows inferior 2-year results for computer-navigated TKR. Orthopedics Today. 2011;May:24–25.
39.
Gothesen O, Espehaug B, Havelin L, Petursson G, Furnes O. Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008. Acta Orthop. 2011;82:293–300.PubMedCrossRef
40.
Graham DJ, Harvie P, Sloan K, Beaver RJ. Morbidity of navigated vs conventional total knee arthroplasty: a retrospective review of 327 cases. J Arthroplasty. 2011;26:1224–1227.PubMedCrossRef
41.
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.PubMedCrossRef
42.
Harvie P, Sloan K, Beaver RJ. Computer navigation vs conventional total knee arthroplasty five-year functional results of a prospective randomized trial. J Arthroplasty. 2011 Sep 27 [Epub ahead of print].
43.
Haytmanek CT, Pour AE, Restrepo C, Nikhil J, Parvizi J, Hozack WJ. Cognition following computer-assisted total knee arthroplasty: a prospective cohort study. J Bone Joint Surg Am. 2010;92:92–97.PubMedCrossRef
44.
Hernandez-Vaquero D, Suarez-Vazquez A. Complications of fixed infrared emitters in computer-assisted total knee arthroplasties. BMC Musculoskelet Disord. 2007;8:71.PubMedCrossRef
45.
Hernandez-Vaquero D, Suarez-Vazquez A, Iglesias-Fernandez S. Can computer assistance improve the clinical and functional scores in total knee arthroplasty? Clin Orthop Relat Res. 2011;469:3436–3442.PubMedCrossRef
46.
Hernandez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A. Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res. 2010;468:1237–1241.PubMedCrossRef
47.
Hiscox CM, Bohm ER, Turgeon TR, Hedden DR, Burnell CD. Randomized trial of computer-assisted knee arthroplasty: impact on clinical and radiographic outcomes. J Arthroplasty. 2011;26:1259–1264.PubMedCrossRef
48.
Hoffart HE, Langenstein E, Vasak N. A prospective study comparing the patient functional knee scores of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br. 2010;94:194–194.
49.
Hoke D, Jafari SM, Orozco F, Ong A. Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty. 2011;26:504.e505–508.
50.
Ishida K, Matsumoto T, Tsumura N, Kubo S, Kitagawa A, Chin T, Iguchi T, Kurosaka M, Kuroda R. Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:1107–1112.PubMedCrossRef
51.
Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709–714.PubMed
52.
Jenny JY, Boeri C. Computer-assisted implantation of total knee prostheses: a case-control comparative study with classical instrumentation. Comput Aided Surg. 2001;6:217–220.PubMedCrossRef
53.
Jung HJ, Jung YB, Song KS, Park SJ, Lee JS. Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am. 2007;89:2280–2284.PubMedCrossRef
54.
Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ. Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty. 2011;26:505.e509–505.e511.
55.
Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ. Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009;17:286–292.PubMedCrossRef
56.
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;88:198–202.PubMed
57.
Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE. Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop. 2009;33:1567–1570.PubMedCrossRef
58.
Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86:1909–1916.PubMedCrossRef
59.
Kim K, Kim YH, Park WM, Rhyu KH. Stress concentration near pin holes associated with fracture risk after computer navigated total knee arthroplasty. Comput Aided Surg. 2010;15:98–103.PubMedCrossRef
60.
Kim SJ, MacDonald M, Hernandez J, Wixson RL. Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty. 2005;20(Suppl 3):123–131.PubMedCrossRef
61.
Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14–19.PubMedCrossRef
62.
Kim YH, Kim JS, Hong KS, Kim YJ, Kim JH. Prevalence of fat embolism after total knee arthroplasty performed with or without computer navigation. J Bone Joint Surg Am. 2008;90:123–128.PubMedCrossRef
63.
Kim YH, Kim JS, Yoon SH. Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br. 2007;89:471–476.PubMedCrossRef
64.
Klein GR, Austin MS, Smith EB, Hozack WJ. Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia. J Arthroplasty. 2006;21:284–288.PubMedCrossRef
65.
Kumar PJ, Dorr LD. Severe malalignment and soft-tissue imbalance in total knee arthroplasty. Am J Knee Surg. 1997;10:36–41.PubMed
66.
Laskin RS, Beksac B. Computer-assisted navigation in TKA: where we are and where we are going. Clin Orthop Relat Res. 2006;452:127–131.PubMedCrossRef
67.
Lee DH, Padhy D, Lee SH, Nha KW, Park JH, Han SB. Osteoporosis affects component positioning in computer navigation-assisted total knee arthroplasty. Knee. 2011 Apr 27 [Epub ahead of print].
68.
Li CH, Chen TH, Su YP, Shao PC, Lee KS, Chen WM. Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system. J Arthroplasty. 2008;23:304–307.PubMedCrossRef
69.
Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2009;24:570–578.PubMedCrossRef
70.
Lutzner J, Gunther KP, Kirschner S. Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2010;18:1339–1344.PubMedCrossRef
71.
Lutzner J, Krummenauer F, Wolf C, Gunther KP, Kirschner S. Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br. 2008;90:1039–1044.PubMedCrossRef
72.
Macule-Beneyto F, Hernandez-Vaquero D, Segur-Vilalta JM, Colomina-Rodriguez R, Hinarejos-Gomez P, Garcia-Forcada I, Seral Garcia B. Navigation in total knee arthroplasty. A multicenter study. Int Orthop. 2006;30:536–540.PubMedCrossRef
73.
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;16:635–640.PubMedCrossRef
74.
Manley M, Ong K, Lau E, Kurtz SM. Total knee arthroplasty survivorship in the United States Medicare population: effect of hospital and surgeon procedure volume. J Arthroplasty. 2009;24:1061–1067.PubMedCrossRef
75.
Manzotti A, Cerveri P, De Momi E, Pullen C, Confalonieri N. Relationship between cutting errors and learning curve in computer-assisted total knee replacement. Int Orthop. 2010;34:655–662.PubMedCrossRef
76.
Manzotti A, Confalonieri N, Pullen C. Intra-operative tibial fracture during computer assisted total knee replacement: a case report. Knee Surg Sports Traumatol Arthrosc. 2008;16:493–496.PubMedCrossRef
77.
Marchant DC, Rimmington DP, Nusem I, Crawford RW. Safe femoral pin placement in knee navigation surgery: a cadaver study. Comput Aided Surg. 2004;9:257–260.PubMed
78.
Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22:1097–1106.PubMedCrossRef
79.
Matsumoto T, Tsumura N, Kurosaka M, Muratsu H, Yoshiya S, Kuroda R. Clinical values in computer-assisted total knee arthroplasty. Orthopedics. 2006;29:1115–1120.PubMed
80.
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C. A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am. 2007;89:236–243.PubMedCrossRef
81.
Millar NL, Deakin AH, Millar LL, Kinnimonth AW, Picard F. Blood loss following total knee replacement in the morbidly obese: effects of computer navigation. Knee. 2011;18:108–112.PubMedCrossRef
82.
Minoda Y, Kobayashi A, Iwaki H, Mitsuhiko I, Kadoya Y, Ohashi H, Takaoka K, Nakamura H. The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18:718–722.PubMedCrossRef
83.
Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y. The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br. 2008;90:1025–1031.PubMedCrossRef
84.
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;15:75–79.PubMedCrossRef
85.
Mombert M, Van Den Daelen L, Gunst P, Missinne L. Navigated total knee arthroplasty: a radiological analysis of 42 randomised cases. Acta Orthop Belg. 2007;73:49–54.PubMed
86.
Morawa LG, Manley MT, Edidin AA, Reilly DT. Transesophageal echocardiographic monitored events during total knee arthroplasty. Clin Orthop Relat Res. 1996;331:192–198.PubMedCrossRef
87.
National Joint Registry for England and Wales 6th Annual Report. Hemel, Hempstead, UK: NJR Centre; 2009:72.
88.
Novak EJ, Silverstein MD, Bozic KJ. The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2389–2397.PubMedCrossRef
89.
Novicoff WM, Saleh KJ, Mihalko WM, Wang XQ, Knaebel HP. Primary total knee arthroplasty: a comparison of computer-assisted and manual techniques. Instr Course Lect. 2010;59:109–17.PubMed
90.
O’Connor MI, Brodersen MP, Feinglass NG, Leone BJ, Crook JE, Switzer BE. Fat emboli in total knee arthroplasty: a prospective randomized study of computer-assisted navigation vs standard surgical technique. J Arthroplasty. 2010;25:1034–1040.PubMedCrossRef
91.
Oberst M, Bertsch C, Wurstlin S, Holz U. [CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study] [in German]. Unfallchirurg. 2003;106:941–948.PubMed
92.
Ohmann C, Verde PE, Blum K, Fischer B, de Cruppé W, Geraedts M. Two short-term outcomes after instituting a national regulation regarding minimum procedural volumes for total knee replacement. J Bone Joint Surg Am. 2010;92:629–638.PubMedCrossRef
93.
Ooi LH, Lo NN, Yeo SJ, Ong BC, Ding ZP, Lefi A. Does computer-assisted surgical navigation total knee arthroplasty reduce venous thromboembolism compared with conventional total knee arthroplasty? Singapore Med J. 2008;49:610–614.PubMed
94.
Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computer navigated total knee arthroplasty. Knee. 2006;13:397–399.PubMedCrossRef
95.
Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am. 2010;92:2143–2149.PubMedCrossRef
96.
Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res. 1999;367:165–171.PubMedCrossRef
97.
Perlick L, Bathis H, Tingart M, Perlick C, Grifka J. Navigation in total-knee arthroplasty: CT-based implantation compared with the conventional technique. Acta Orthop Scand. 2004;75:464–470.PubMedCrossRef
98.
Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res. 1988;232:168–173.PubMed
99.
Rauh MA, Boyle J, Mihalko WM, Phillips MJ, Bayers-Thering M, Krackow KA. Reliability of measuring long-standing lower extremity radiographs. Orthopedics. 2007;30:299–303.PubMed
100.
Restrepo C, Hozack WJ, Orozco F, Parvizi J. Accuracy of femoral rotational alignment in total knee arthroplasty using computer assisted navigation. Comput Aided Surg. 2008;13:167–172.PubMed
101.
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.PubMed
102.
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRef
103.
Schmitt J, Hauk C, Kienapfel H, Pfeiffer M, Efe T, Fuchs-Winkelmann S, Heyse TJ. Navigation of total knee arthroplasty: rotation of components and clinical results in a prospectively randomized study. BMC Musculoskelet Disord. 2011;12:16.PubMedCrossRef
104.
Schnurr C, Csecsei G, Eysel P, Konig DP. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics. 2010;33:474.PubMed
105.
Seon JK, Song EK. Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty. 2006;21:777–782.PubMedCrossRef
106.
Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG. Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg. 2007;12:189–193.PubMed
107.
Seon JK, Song EK, Yoon TR, Seo HY, Cho SG. Tibial plateau stress fracture after unicondylar knee arthroplasty using a navigation system: two case reports. Knee Surg Sports Traumatol Arthrosc. 2007;15:67–70.PubMedCrossRef
108.
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.PubMedCrossRef
109.
Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br. 2008;90:1121–1127.PubMed
110.
Sikorski JM, Blythe MC. Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br. 2005;87:903–910.PubMed
111.
Song EK, Seon JK, Yoon TR, Park SJ, Cho SG, Yim JH. Comparative study of stability after total knee arthroplasties between navigation system and conventional techniques. J Arthroplasty. 2007;22:1107–1111.PubMedCrossRef
112.
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;85:830–835.PubMed
113.
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;89:477–480.PubMedCrossRef
114.
Stiehl JB, Jackson S, Szabo A. Multi-factorial analysis of time efficiency in total knee arthroplasty. Comput Aided Surg. 2009;14:58–62.PubMedCrossRef
115.
Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426:180–186.PubMedCrossRef
116.
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(Suppl 2):90–98.PubMed
117.
Stulberg SD, Yaffe MA, Koo SS. Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am. 2006;88(Suppl 4):47–54.PubMedCrossRef
118.
Tew M, Waugh W. Estimating the survival time of knee replacement. J Bone Joint Surg Br. 1982;64:579–582.PubMed
119.
van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, Nelissen RG. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop. 2011;35:845–850.
120.
Victor J, Hoste D. Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res. 2004;428:131–139.PubMedCrossRef
121.
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.PubMed
122.
Watters TS, Mather RC 3rd, Browne JA, Berend KR, Lombardi AV Jr, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv. 2011;20:112–116.PubMed
123.
Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty. 2009;24:668–673.PubMedCrossRef
124.
Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ. Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplasty. 2008;23:462–465.PubMedCrossRef
125.
Yaffe MA, Koo SS, Stulberg SD. Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res. 2008;466:2736–2744.PubMedCrossRef
126.
Yang JH, Seo JG, Moon YW, Kim MH. Joint line changes after navigation-assisted mobile-bearing TKA. Orthopedics. 2009;32(Suppl):35–39.PubMedCrossRef
127.
Zhang G, Chen J, Chai W, Liu M, Wang Y. Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures. A randomized clinical trial. J Bone Joint Surg Am. 2011;93:1190–1196.PubMedCrossRef
128.
Zorman D, Etuin P, Jennart H, Scipioni D, Devos S. Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases. Acta Orthop Belg. 2005;71:696–702.PubMed
129.
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.PubMedCrossRef
Metadata
Title
Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review
Authors
R. Stephen J. Burnett, MD, FRCSCC
Robert L. Barrack, MD
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2528-8

Other articles of this Issue 1/2013

Clinical Orthopaedics and Related Research® 1/2013 Go to the issue

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Low Risk of Thromboembolic Complications With Tranexamic Acid After Primary Total Hip and Knee Arthroplasty

Survey

Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Voriconazole Is Delivered From Antifungal-Loaded Bone Cement

Clinical Research

Does Humeral Lengthening With a Monolateral Frame Improve Function?

Survey

Do Patients Lose Weight After Joint Arthroplasty Surgery? A Systematic Review

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Patient-specific Total Knee Arthroplasty Required Frequent Surgeon-directed Changes