Meta-Analysis of Navigation vs Conventional Total Knee Arthroplasty

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Abstract

Navigated total knee arthroplasty (TKA) is promoted as a means to improve limb and prosthesis alignment. This study involved a systematic review and meta-analysis for all randomized controlled trials in the literature from 1986 to 2009 comparing alignment outcomes between navigated and conventional TKA. Alignment outcomes were pooled using a random-effects model, and heterogeneity was explored. Twenty-three randomized controlled trials were identified comparing navigated vs conventional TKA involving 2541 patients. Patients who underwent navigated TKA had a significantly lower risk of implant malalignment at more than 3° as well as more than 2°. In addition, the risk of malalignment was reduced for the coronal plane tibial and femoral components as well as femoral and tibial slope. This meta-analysis demonstrates that navigated TKA provides significant improvement in prosthesis alignment.

Section snippets

Methods

An extensive search of the literature from 1986 to November 30, 2009, was performed for the following database: PubMed, Cochrane, Medline, and EMBASE as well as major medical and publisher databases exclusively for RCTs comparing navigated and conventional arthroplasty. The following search terms were used: total knee replacement, total knee arthroplasty, conventional, navigation, clinical trial, meta-analysis. A search of the references of recent meta-analyses on the subject was also

Results

The results of the initial search yielded 160 citations, which were retrieved for review. After application of exclusion criteria and removal of duplicate titles, 27 RCTs were assessed, of which 2 studies were excluded because of lack of relevance and a further 2 were excluded because they were meta-analyses. Of these 23 studies 7, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 20 were in the English language, 1 was in French, and 2 were in German. In

Discussion

Previous studies have demonstrated that implant malalignment may lead to early implant failure [39]. This has been shown to result from asymmetric tibiafemoral tracking and subsequent abnormal stresses at the weight-bearing surfaces. In particular, it has been shown that increased risk of implant failure is seen with implant alignment that is greater than 3° from neutral mechanical axis [40]. In a study by Jeffery et al [4], it was reported that aseptic loosening of implants in patients with

References (41)

  • R.S. Jeffery et al.

    Coronal alignment after total knee replacement

    J Bone Joint Surg Br

    (1991)
  • J.N. Insall

    Choices and compromises in total knee arthroplasty

    Clin Orthop Relat Res

    (1988)
  • S.L. Delp et al.

    Computer assisted knee replacement

    Clin Orthop Relat Res

    (1998)
  • M. Sparmann et al.

    Positioning of total knee arthroplasty with and without navigation support

    J Bone Joint Surg Br

    (2003)
  • K. Bauwens et al.

    Navigated total knee replacement. A meta-analysis

    J Bone Joint Surg Am

    (2007)
  • J.B. Mason et al.

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

    J Arthroplasty

    (2007)
  • M. Bhandari et al.

    The quality of reporting of randomized trials in The Journal of Bone and Joint Surgery from 1988 through 2000

    J Bone Joint Surg Am

    (2002)
  • M.J. Dunbar et al.

    Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry

    J Bone Joint Surg Br

    (2001)
  • J.E. Ware et al.

    User's manual for the SF-36v2 Health Survey (2nd ed.)

    (2007)
  • C.M. Bach et al.

    Scoring systems in total knee arthroplasty

    Clin Orthop Related Res

    (2002)
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    The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.12.028.

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