Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 11, pp 3482–3495 | Cite as

Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis

  • Jelle P. van der ListEmail author
  • Harshvardhan Chawla
  • Leo Joskowicz
  • Andrew D. Pearle


Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.


Computer navigation Robotics Unicompartmental knee arthroplasty Total knee arthroplasty Soft tissue balancing 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


No funding has been received for this study.

Ethical approval

Ethical approval was not obtained because this study was a literature review.

Informed consent

Informed consent was not obtained because this study was a literature review.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Jelle P. van der List
    • 1
    Email author
  • Harshvardhan Chawla
    • 1
  • Leo Joskowicz
    • 2
  • Andrew D. Pearle
    • 1
  1. 1.Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Computer Assisted Surgery and Medical Image Processing Laboratory, School of Engineering and Computer ScienceHebrew UniversityJerusalemIsrael

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