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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 27-09-2022 | KNEE

No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

Authors: Omer M. Farhan-Alanie, Tareq Altell, Sinead O’Donnell, Pauline May, James Doonan, Philip Rowe, Bryn Jones, Mark J. G. Blyth

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

Abstract

Purpose

Computer-assisted surgery (CAS) total knee arthroplasty (TKA) remains a controversial area of surgical practice. The aim of this study is to report the ten-year revision rates and patient-reported outcome measures (PROMS) of a single-blinded, prospective, randomised controlled trial comparing electromagnetically (EM) navigated and conventional TKA.

Methods

199 patients were randomised to receive either EM navigated or conventional TKA where the aim of implantation was neutral mechanical alignment in all cases. Ten-year revision rates were collated and compared between the two intervention groups. Longitudinal PROMS data was collected prospectively at various time points up to 10 years post-operatively.

Results

Over the ten-year period, there were 23 deaths (22.8%) in the EM navigation cohort and 30 deaths (30.6%) in the conventional cohort. At 10 years post-operatively, there was no statistically significant difference in all cause revision between the EM navigation and conventional cohort (4.0 vs 6.1%, p = 0.429). When analysing causes of revision that might be influenced by utilising EM navigation, there was no statistically significant difference in revisions (3.0% EM navigated vs 4.1% conventional group, p = 0.591). Patients that received navigated TKAs had improved Oxford Knee Society, American Knee Society Score and range of motion at 3 months following surgery compared to conventional TKA (p = 0.002, p = 0.032, and p = 0.05, respectively). However, from 1 to 10 years post-operatively, both interventions had equivalent outcomes.

Conclusion

There is no difference in revision rates or clinical outcomes comparing EM navigated versus conventional TKA at ten-year follow-up. The expected mortality rate makes it unlikely that a difference in revision rates will reach statistical significance in the future. In the setting of an experienced knee arthroplasty surgeon, it is difficult to justify the additional costs of CAS in TKA surgery.

Level of evidence

AOANJRR (2019) Hip, Knee & Shoulder Arthroplasty: 2019 Annual Report. Adelaide: AOA

Blyth M, Smith J, Anthony I, Strict N, Rowe P, Jones B (2015) Electromagnetic navigation in total knee arthroplasty-a single center, randomized, single-blind study comparing the results with conventional techniques. J Arthroplasty 30:199e205CrossRef

Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M (2017) PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 25:1743–1748CrossRefPubMed

Clark AN, Hounat A, O’Donnell S, May P, Doonan J, Rowe P, Jones BG, Blyth MJG (2021) Electromagnetic navigated versus conventional total knee arthroplasty-a five-year follow-up of a single-blind randomized control trial. J Arthroplasty 36(10):3451–3455CrossRefPubMed

de Steiger RN, Liu Y-L, Graves SE (2015) Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 97:635e42CrossRef

Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J 96-B:907–913CrossRefPubMed

Gøthesen O, Espehaug B, Havelin L, Petursson G, Furnes O (2011) Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008. Acta Orthop 82(3):293–300CrossRefPubMedPubMedCentral

Gøthesen Ø, Slover J, Havelin L, Askildsen JE, Malchau H, Furnes O (2013) An economic model to evaluate cost-effectiveness of computer assisted knee replacement surgery in Norway. BMC Musculoskelet Disord 14:202CrossRefPubMedPubMedCentral

Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty 27(6):1177–1182CrossRefPubMed

10.

Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty 26:504e8CrossRef

11.

Ishikawa M, Kuriyama S, Ito H, Furu M, Nakamura S, Matsuda S (2015) Kinematic alignment produces near-normal knee motion but increases contact stress after total knee arthroplasty: a case study on a single implant design. Knee 22(3):206–212CrossRefPubMed

12.

Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714CrossRefPubMed

13.

Kim YH, Park JW, Kim JS (2017) The clinical outcome of computer-navigated compared with conventional knee arthroplasty in the same patients: a prospective, randomized, double-blind, long-term study. J Bone Joint Surg Am 99(12):989–996CrossRefPubMed

14.

Lee DH, Park JH, Song DI, Padhy D, Jeong WK, Han SB (2010) Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc 18(3):381–387CrossRefPubMed

15.

Lee BS, Cho HI, Bin SI, Kim JM, Jo BK (2018) Femoral component varus malposition is associated with tibial aseptic loosening after TKA. Clin Orthop Relat Res 476(2):400–407CrossRefPubMedPubMedCentral

16.

Liu HX, Shang P, Ying XZ, Zhang Y (2016) Shorter survival rate in varus-aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(8):2663–2671CrossRefPubMed

17.

National Joint Registry for England and Wales. 21st Annual Report 2021. Hemel Hempstead, Hertfordshire, UK: NJR Centre; 2021. Report No. 21

18.

Panjwani TR, Mullaji A, Doshi K, Thakur H (2019) Comparison of functional outcomes of computer-assisted vs conventional total knee arthroplasty: a systematic review and meta-analysis of high-quality prospective studies. J Arthroplasty 34(3):586–593CrossRefPubMed

19.

Picard F, Clarke J, Deep K, Gregori A (2014) Computer assisted knee replacement surgery: is the movement mainstream? Orthop Musc Syst 3:2

20.

Population estimates for the UK, England and Wales, Scotland and Northern Ireland -Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2019estimates#internal-migration. Accessed 20 Nov 2021

21.

Rhee SJ, Kim HJ, Lee CR, Kim CW, Gwak HC, Kim JH (2019) A comparison of long-term outcomes of computer-navigated and conventional total knee arthroplasty: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 101(20):1875–1885CrossRefPubMed

22.

Roussot MA, Vles GF, Oussedik S (2020) Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review. EFORT Open Rev 5(8):486–497CrossRefPubMedPubMedCentral

23.

Rivière C, Iranpour F, Auvinet E, Howell S, Vendittoli PA, Cobb J, Parratte S (2017) Alignment options for total knee arthroplasty: a systematic review. Orthop Traumatol Surg Res 103(7):1047–1056CrossRefPubMed

24.

Scottish Index of Multiple Deprivation 2020v2 – ranks. gov.scot https://www.gov.scot/publications/scottish-index-of-multiple-deprivation-2020v2-ranks/. Accessed 20 Nov 2021

25.

Slover JD, Tosteson ANA, Bozic KJ, Rubash HE, Malchau H (2008) Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am 90:1492–1500CrossRefPubMedPubMedCentral

26.

Steel D, Cylus J (2012) United Kingdom (Scotland): health system review. Health Syst Transit 14:1e150

27.

Trieu J, Schilling C, Dowsey MM, Choong PF (2021) The cost-effectiveness of computer navigation in primary total knee replacement: a scoping review. EFORT Open Rev 6(3):173–180CrossRefPubMedPubMedCentral

28.

van der List JP, Chawla H, Joskowicz L, Pearle AD (2016) Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 24:3482e95

29.

Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD (2016) The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Joint J 98-B:1360–1368CrossRefPubMed

30.

Young SW, Walker ML, Bayan A, Briant-Evans T, Pavlou P, Farrington B (2017) The Chitranjan S. Ranawat Award: No difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial. Clin Orthop Relat Res 475(1):9–20CrossRefPubMed

Title: No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial
Authors: Omer M. Farhan-Alanie
Tareq Altell
Sinead O’Donnell
Pauline May
James Doonan
Philip Rowe
Bryn Jones
Mark J. G. Blyth
Publication date: 27-09-2022
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-022-07158-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

No advantage with navigated versus conventional mechanically aligned total knee arthroplasty—10 year results of a randomised controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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