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Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis

Knee Surgery, Sports Traumatology, Arthroscopy volume 30, pages 721–733 (2022)Cite this article

Abstract

Purpose

To achieve the desired alignment more accurately and improve postoperative outcomes, new techniques such as computer navigation (Navigation), patient-specific instruments (PSI) and surgical robots (Robot) are applied in Total Knee Arthroplasty (TKA). This network meta-analysis aims to compare the radiological and clinical outcomes among the above-mentioned techniques and conventional instruments (CON).

Methods

A PRISMA network meta-analysis was conducted and study protocol was published online at INPLASY (INPLASY202060018). Three databases (PubMed, EMBASE and Cochrane) were searched up to June 1, 2020. Randomised controlled trials (RCTs) comparing any two of the four techniques were included. A Bayesian network meta-analysis was performed focusing on radiological and clinical outcomes. The odds ratio (OR) or mean difference (MD) in various outcomes were calculated, and the interventions were ranked by the surface under the cumulative ranking area (SUCRA) value.

Results

Seventy-three RCTs were included, with a total of 4209 TKAs. Navigation and Robot could significantly reduce the occurrence of malalignment and malposition compared with PSI and CON, and Navigation could obtain higher medium-and-long-term KSS knee scores than CON. Robot had the greatest advantage in achieving the desired alignment accurately, followed by Navigation; Navigation had the greatest advantage in the KSS score.

Conclusion

Navigation and Robot did improve the accuracy of alignment compared with PSI and conventional instrument in TKA, but the above four techniques showed no clinical significance in postoperative outcomes.

Level of evidence

I

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Abbreviations

TKA:

Total knee arthroplasty

Navigation:

Computer navigation

Robot:

Surgical robots

PSI:

Patient-specific instruments

CON:

Conventional TKA

NMA:

Network meta-analysis

RCTs:

Randomised controlled trials

OR:

Odds ratio

MD:

Mean difference

SUCRA:

Surface under the cumulative ranking area

PROM:

Patient-reported outcome measures

MCID:

Minimal clinically important difference

KSS:

Knee Society Knee Scoring System

WOMAC:

Western Ontario and McMaster University osteoarthritis index scores

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Funding

There was no financial conflict of interest with regards to this study.

Author information

Affiliations

  1. Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China

    Kai Lei, LiMing Liu, Xin Chen, Liu Yang & Lin Guo

  2. Minimally Invasive Gastrointestinal Surgery Center, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China

    Qing Feng

Authors
  1. Kai Lei
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  2. LiMing Liu
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  3. Xin Chen
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  4. Qing Feng
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  5. Liu Yang
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  6. Lin Guo
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Contributions

XC and KL composed the manuscript; LML and KL participated in the search, data extraction and quality assessment work; QF and KL completed the statistical analysis; LG and LY conceived the idea of the study. All the authors contributed to the writing of the manuscript and approved the final manuscript.

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Correspondence to Lin Guo.

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Lei, K., Liu, L., Chen, X. et al. Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 721–733 (2022). https://doi.org/10.1007/s00167-021-06436-8

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  • DOI: https://doi.org/10.1007/s00167-021-06436-8

Keywords

  • Total knee replacement
  • Total knee arthroplasty
  • Computer navigation
  • Robotics
  • Patient-specific instruments
  • Network meta-analysis