Does Imageless Computer-assisted TKA Lead to Improved Rotational Alignment or Fewer Outliers? A Systematic Review
- 408 Downloads
Computer-assisted surgery (CAS) has been developed to enhance prosthetic alignment during primary TKAs. Imageless CAS improves coronal and sagittal alignment compared with conventional TKA. However, the effect of imageless CAS on rotational alignment remains unclear.
We conducted a systematic and qualitative review of the current literature regarding the effectiveness of imageless CAS during TKA on (1) rotational alignment of the femoral and tibial components and tibiofemoral mismatch in terms of deviation from neutral rotation, and (2) the number of femoral and tibial rotational outliers.
Data sources included PubMed, MEDLINE, and EMBASE. Study selection, data extraction, and methodologic quality assessment were conducted independently by two reviewers. Standardized mean difference with 95% CI was calculated for continuous variables (rotational alignment of the femoral or tibial component and tibiofemoral mismatch). To compare the number of outliers for femoral and tibial component rotation, the odds ratio and 95% CI were calculated. The literature search produced 657 potentially relevant studies, 17 of which met the inclusion criteria. One study was considered as having high methodologic quality, 15 studies had medium, and one study had low quality.
Conflicting evidence was found for all outcome measures except for tibiofemoral mismatch. Moderate evidence was found that imageless CAS had no influence on postoperative tibiofemoral mismatch. The measurement protocol for measuring tibial rotation varied among the studies and in only one of the studies was the sample size calculation based on one of the outcome measures used in our systematic review.
More studies of high methodologic quality and with a sample size calculation based on the outcome measures will be helpful to assess whether an imageless CAS TKA improves femoral and tibial rotational alignment and tibiofemoral mismatch or decreases the number of femoral and tibial rotational outliers. To statistically analyze the results of different studies, the same measurement protocol should be used among the studies.
KeywordsMethodologic Quality Femoral Component Aseptic Loosening Tibial Component Standardize Mean Difference
We thank Truus van Ittersum (literature retrieval specialist, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands) for her contribution to the literature search strategy.
- 1.Australian Orthopaedic Association National Joint Replacement Registry. Hip and knee arthroplasty: annual report 2010. Available at: https://aoanjrr.dmac.adelaide.edu.au/documents/10180/42844/Annual%20Report%202010?version=1&t=1349406187793. Accessed March 9, 2013.
- 14.Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 1988.Google Scholar
- 15.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.PubMedCrossRefGoogle Scholar
- 32.Matos LFC, Alves ALQ, Sobreiro AL, Giordano MN, Albuquerque RSP, Carvalho ACP Carvalho Matos LF, Quintas Alves AL, Sobreiro AL, Giordano MN, Pires de Albuquerque RS, Pires Carvalho AC. [Navigation in total knee arthroplasty: is there any advantage?][in Portuguese]. Acta Ortop Bras. 2011;19:184-188. Available at: http://www.scielo.br/pdf/aob/v19n4/en_02.pdf. Accessed February 22, 2014.
- 38.Reininga IH, Zijlstra W, Wagenmakers R, Boerboom AL, Huijbers BP, Groothoff JW, Bulstra SK, Stevens SM. Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature. BMC Musculoskelet Disord. 2010;11:92.PubMedCrossRefPubMedCentralGoogle Scholar
- 42.Shrier I, Boivin JF, Steele RJ, Platt RW, Furlan A, Kakuma R, Brophy J, Rossignol M. Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol. 2007;166:1203–1209.PubMedCrossRefGoogle Scholar
- 45.Swedish Knee Arthroplasty Register. 2010 annual report. Available at: http://www.knee.nko.se/english/online/uploadedFiles/114_SKAR2010_Eng1.0.pdf. Accessed March 9, 2013.
- 46.van Tulder M, Furlan A, Bombardier C, Bouter L; Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2003;28:1290–1299.Google Scholar