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Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 264–276 | Cite as

Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review

  • R. Stephen J. Burnett
  • Robert L. Barrack
Symposium: Papers Presented at the Annual Meetings of the Knee Society

Abstract

Background

Navigated total knee arthroplasty (TKA) may improve coronal alignment outliers; however, it is unclear whether navigated TKA improves the long-term clinical results of TKA.

Questions/Purposes

Does the literature contain evidence of better long-term function and lower revision rates with navigated TKA compared with conventional TKA?

Methods

A systematic literature review was conducted of navigated TKA reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction, component rotation, anteroposterior and mediolateral stability, complications, and longer-term reports.

Results

Coronal plane alignment is improved with navigated TKA with fewer radiographic outliers. We found limited evidence of improvements in any other variable, and function was not improved. The duration of surgery is increased and there are unique complications related to navigated TKA. The long-term benefits of additional increase in accuracy of alignment are not supported by any current evidence.

Conclusions

The findings in reports of navigated TKA should be interpreted with caution. There are few short- and medium- and no long-term studies demonstrating improved clinical outcomes using navigated TKA. Despite substantial research, contradictory findings coupled with reservations about the cost and efficacy of the technology have contributed to the failure of computer navigation to become the accepted standard in TKA. Longer-term studies demonstrating improved function, lower revision rates, and acceptable costs are required before navigated TKA may be widely adopted. In the future, with improvements in study design, methodology, imaging, navigation technology, newer functional outcome tools, and longer-term followup studies, we suspect that navigated TKA may demonstrate yet unrecognized benefits.

Keywords

Total Knee Arthroplasty Mechanical Axis Operating Room Time Coronal Alignment Conventional Total Knee Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Alan RK, Shin MS, Tria AJ Jr. Initial experience with electromagnetic navigation in total knee arthroplasty: a radiographic comparative study. J Knee Surg. 2007;20:152–157.PubMedGoogle Scholar
  2. 2.
    Australian Orthopaedic Association National Joint Replacement Registry. Computer Assisted Surgery in Primary Total Knee Replacement Between 2006 and 2008. Adelaide, Australia: AOA NJRR; 2010.Google Scholar
  3. 3.
    Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PF. Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Joint Surg Br. 2011;93:1223–1231.PubMedCrossRefGoogle Scholar
  4. 4.
    Barrack RL, Barnes CL, Burnett RS, Miller D, Clohisy JC, Maloney WJ. Minimal incision surgery as a risk factor for early failure of total knee arthroplasty. J Arthroplasty. 2009;24:489–498.PubMedCrossRefGoogle Scholar
  5. 5.
    Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res. 2001;392:46–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Barrett WP, Mason JB, Moskal JT, Dalury DF, Oliashirazi A, Fisher DA. Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. J Arthroplasty. 2011;26:1273–1284.e1271.Google Scholar
  7. 7.
    Bathis H, Perlick L, Tingart M, Luring C, Grifka J. CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. Orthopedics. 2004;27:476–480.PubMedGoogle Scholar
  8. 8.
    Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J. Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop. 2004;28:87–90.PubMedCrossRefGoogle Scholar
  9. 9.
    Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004;86:682–687.PubMedCrossRefGoogle Scholar
  10. 10.
    Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007;89:261–269.PubMedCrossRefGoogle Scholar
  11. 11.
    Bejek Z, Solyom L, Szendroi M. Experiences with computer navigated total knee arthroplasty. Int Orthop. 2007;31:617–622.PubMedCrossRefGoogle Scholar
  12. 12.
    Beldame J, Boisrenoult P, Beaufils P. Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res. 2010;96:249–255.PubMedCrossRefGoogle Scholar
  13. 13.
    Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res. 2012;470:45–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;428:26–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998;356:144–153.PubMedCrossRefGoogle Scholar
  16. 16.
    Blakeney WG, Khan RJ, Wall SJ. Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93:1377–1384.PubMedCrossRefGoogle Scholar
  17. 17.
    Bohling U, Schamberger H, Grittner U, Scholz J. Computerised and technical navigation in total knee arthroplasty. J Orthop Traumatol. 2005;6:69–75.CrossRefGoogle Scholar
  18. 18.
    Bolognesi M, Hofmann A. Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res. 2005;440:162–169.PubMedCrossRefGoogle Scholar
  19. 19.
    Bonutti P, Dethmers D, Stiehl JB. Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res. 2008;466:1499–1502.PubMedCrossRefGoogle Scholar
  20. 20.
    Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA. Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res. 2008;466:2756–2762.PubMedCrossRefGoogle Scholar
  21. 21.
    Bonutti PM, Dethmers DA, McGrath MS, Ulrich SD, Mont MA. Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res. 2008;466:2730–2735.PubMedCrossRefGoogle Scholar
  22. 22.
    Bottros J, Klika AK, Lee HH, Polousky J, Barsoum WK. The use of navigation in total knee arthroplasty for patients with extra-articular deformity. J Arthroplasty. 2008;23:74–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J. Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop. 2011;35:331–339.PubMedCrossRefGoogle Scholar
  24. 24.
    Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br. 2004;86:372–377.PubMedCrossRefGoogle Scholar
  25. 25.
    Cheng T, Zhang G, Zhang X. Clinical and radiographic outcomes of image-based computer-assisted total knee arthroplasty: an evidence-based evaluation. Surg Innov. 2011;18:15–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Cheung KW, Chiu KH. Imageless computer navigation in total knee arthroplasty. Hong Kong Med J. 2009;15:353–358.PubMedGoogle Scholar
  27. 27.
    Chin PL, Yang KY, Yeo SJ, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty. 2005;20:618–626.PubMedCrossRefGoogle Scholar
  28. 28.
    Choi WC, Lee S, An JH, Kim D, Seong SC, Lee MC. Plain radiograph fails to reflect the alignment and advantages of navigation in total knee arthroplasty. J Arthroplasty. 2011;26:756–764.PubMedCrossRefGoogle Scholar
  29. 29.
    Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty. 2009;24:560–569.PubMedCrossRefGoogle Scholar
  30. 30.
    Chung BJ, Kang YG, Chang CB, Kim SJ, Kim TK. Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res. 2009;467:2403–2413.PubMedCrossRefGoogle Scholar
  31. 31.
    Church JS, Scadden JE, Gupta RR, Cokis C, Williams KA, Janes GC. Embolic phenomena during computer-assisted and conventional total knee replacement. J Bone Joint Surg Br. 2007;89:481–485.PubMedCrossRefGoogle Scholar
  32. 32.
    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
  33. 33.
    Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty. 2005;20:282–288.PubMedCrossRefGoogle Scholar
  34. 34.
    Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res. 1998;354:49–56.PubMedCrossRefGoogle Scholar
  35. 35.
    Dong H, Buxton M. Early assessment of the likely cost-effectiveness of a new technology: a Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement. Int J Technol Assess Health Care. 2006;22:191–202.PubMedCrossRefGoogle Scholar
  36. 36.
    Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res. 2007;457:156–162.PubMedGoogle Scholar
  37. 37.
    Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am. 1986;68:1035–1040.PubMedGoogle Scholar
  38. 38.
    Gothesen O. Norwegian register shows inferior 2-year results for computer-navigated TKR. Orthopedics Today. 2011;May:24–25.Google Scholar
  39. 39.
    Gothesen O, Espehaug B, Havelin L, Petursson G, Furnes O. Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008. Acta Orthop. 2011;82:293–300.PubMedCrossRefGoogle Scholar
  40. 40.
    Graham DJ, Harvie P, Sloan K, Beaver RJ. Morbidity of navigated vs conventional total knee arthroplasty: a retrospective review of 327 cases. J Arthroplasty. 2011;26:1224–1227.PubMedCrossRefGoogle Scholar
  41. 41.
    Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005;433:152–159.PubMedCrossRefGoogle Scholar
  42. 42.
    Harvie P, Sloan K, Beaver RJ. Computer navigation vs conventional total knee arthroplasty five-year functional results of a prospective randomized trial. J Arthroplasty. 2011 Sep 27 [Epub ahead of print].Google Scholar
  43. 43.
    Haytmanek CT, Pour AE, Restrepo C, Nikhil J, Parvizi J, Hozack WJ. Cognition following computer-assisted total knee arthroplasty: a prospective cohort study. J Bone Joint Surg Am. 2010;92:92–97.PubMedCrossRefGoogle Scholar
  44. 44.
    Hernandez-Vaquero D, Suarez-Vazquez A. Complications of fixed infrared emitters in computer-assisted total knee arthroplasties. BMC Musculoskelet Disord. 2007;8:71.PubMedCrossRefGoogle Scholar
  45. 45.
    Hernandez-Vaquero D, Suarez-Vazquez A, Iglesias-Fernandez S. Can computer assistance improve the clinical and functional scores in total knee arthroplasty? Clin Orthop Relat Res. 2011;469:3436–3442.PubMedCrossRefGoogle Scholar
  46. 46.
    Hernandez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A. Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res. 2010;468:1237–1241.PubMedCrossRefGoogle Scholar
  47. 47.
    Hiscox CM, Bohm ER, Turgeon TR, Hedden DR, Burnell CD. Randomized trial of computer-assisted knee arthroplasty: impact on clinical and radiographic outcomes. J Arthroplasty. 2011;26:1259–1264.PubMedCrossRefGoogle Scholar
  48. 48.
    Hoffart HE, Langenstein E, Vasak N. A prospective study comparing the patient functional knee scores of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br. 2010;94:194–194.Google Scholar
  49. 49.
    Hoke D, Jafari SM, Orozco F, Ong A. Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty. 2011;26:504.e505–508.Google Scholar
  50. 50.
    Ishida K, Matsumoto T, Tsumura N, Kubo S, Kitagawa A, Chin T, Iguchi T, Kurosaka M, Kuroda R. Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:1107–1112.PubMedCrossRefGoogle Scholar
  51. 51.
    Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709–714.PubMedGoogle Scholar
  52. 52.
    Jenny JY, Boeri C. Computer-assisted implantation of total knee prostheses: a case-control comparative study with classical instrumentation. Comput Aided Surg. 2001;6:217–220.PubMedCrossRefGoogle Scholar
  53. 53.
    Jung HJ, Jung YB, Song KS, Park SJ, Lee JS. Fractures associated with computer-navigated total knee arthroplasty. A report of two cases. J Bone Joint Surg Am. 2007;89:2280–2284.PubMedCrossRefGoogle Scholar
  54. 54.
    Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ. Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty. 2011;26:505.e509–505.e511.Google Scholar
  55. 55.
    Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ. Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009;17:286–292.PubMedCrossRefGoogle Scholar
  56. 56.
    Kalairajah Y, Cossey AJ, Verrall GM, Ludbrook G, Spriggins AJ. Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomised, clinical trial. J Bone Joint Surg Br. 2006;88:198–202.PubMedGoogle Scholar
  57. 57.
    Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE. Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop. 2009;33:1567–1570.PubMedCrossRefGoogle Scholar
  58. 58.
    Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86:1909–1916.PubMedCrossRefGoogle Scholar
  59. 59.
    Kim K, Kim YH, Park WM, Rhyu KH. Stress concentration near pin holes associated with fracture risk after computer navigated total knee arthroplasty. Comput Aided Surg. 2010;15:98–103.PubMedCrossRefGoogle Scholar
  60. 60.
    Kim SJ, MacDonald M, Hernandez J, Wixson RL. Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty. 2005;20(Suppl 3):123–131.PubMedCrossRefGoogle Scholar
  61. 61.
    Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009;91:14–19.PubMedCrossRefGoogle Scholar
  62. 62.
    Kim YH, Kim JS, Hong KS, Kim YJ, Kim JH. Prevalence of fat embolism after total knee arthroplasty performed with or without computer navigation. J Bone Joint Surg Am. 2008;90:123–128.PubMedCrossRefGoogle Scholar
  63. 63.
    Kim YH, Kim JS, Yoon SH. Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br. 2007;89:471–476.PubMedCrossRefGoogle Scholar
  64. 64.
    Klein GR, Austin MS, Smith EB, Hozack WJ. Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia. J Arthroplasty. 2006;21:284–288.PubMedCrossRefGoogle Scholar
  65. 65.
    Kumar PJ, Dorr LD. Severe malalignment and soft-tissue imbalance in total knee arthroplasty. Am J Knee Surg. 1997;10:36–41.PubMedGoogle Scholar
  66. 66.
    Laskin RS, Beksac B. Computer-assisted navigation in TKA: where we are and where we are going. Clin Orthop Relat Res. 2006;452:127–131.PubMedCrossRefGoogle Scholar
  67. 67.
    Lee DH, Padhy D, Lee SH, Nha KW, Park JH, Han SB. Osteoporosis affects component positioning in computer navigation-assisted total knee arthroplasty. Knee. 2011 Apr 27 [Epub ahead of print].Google Scholar
  68. 68.
    Li CH, Chen TH, Su YP, Shao PC, Lee KS, Chen WM. Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system. J Arthroplasty. 2008;23:304–307.PubMedCrossRefGoogle Scholar
  69. 69.
    Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2009;24:570–578.PubMedCrossRefGoogle Scholar
  70. 70.
    Lutzner J, Gunther KP, Kirschner S. Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2010;18:1339–1344.PubMedCrossRefGoogle Scholar
  71. 71.
    Lutzner J, Krummenauer F, Wolf C, Gunther KP, Kirschner S. Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br. 2008;90:1039–1044.PubMedCrossRefGoogle Scholar
  72. 72.
    Macule-Beneyto F, Hernandez-Vaquero D, Segur-Vilalta JM, Colomina-Rodriguez R, Hinarejos-Gomez P, Garcia-Forcada I, Seral Garcia B. Navigation in total knee arthroplasty. A multicenter study. Int Orthop. 2006;30:536–540.PubMedCrossRefGoogle Scholar
  73. 73.
    Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW. The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty. 2001;16:635–640.PubMedCrossRefGoogle Scholar
  74. 74.
    Manley M, Ong K, Lau E, Kurtz SM. Total knee arthroplasty survivorship in the United States Medicare population: effect of hospital and surgeon procedure volume. J Arthroplasty. 2009;24:1061–1067.PubMedCrossRefGoogle Scholar
  75. 75.
    Manzotti A, Cerveri P, De Momi E, Pullen C, Confalonieri N. Relationship between cutting errors and learning curve in computer-assisted total knee replacement. Int Orthop. 2010;34:655–662.PubMedCrossRefGoogle Scholar
  76. 76.
    Manzotti A, Confalonieri N, Pullen C. Intra-operative tibial fracture during computer assisted total knee replacement: a case report. Knee Surg Sports Traumatol Arthrosc. 2008;16:493–496.PubMedCrossRefGoogle Scholar
  77. 77.
    Marchant DC, Rimmington DP, Nusem I, Crawford RW. Safe femoral pin placement in knee navigation surgery: a cadaver study. Comput Aided Surg. 2004;9:257–260.PubMedGoogle Scholar
  78. 78.
    Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22:1097–1106.PubMedCrossRefGoogle Scholar
  79. 79.
    Matsumoto T, Tsumura N, Kurosaka M, Muratsu H, Yoshiya S, Kuroda R. Clinical values in computer-assisted total knee arthroplasty. Orthopedics. 2006;29:1115–1120.PubMedGoogle Scholar
  80. 80.
    Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C. A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am. 2007;89:236–243.PubMedCrossRefGoogle Scholar
  81. 81.
    Millar NL, Deakin AH, Millar LL, Kinnimonth AW, Picard F. Blood loss following total knee replacement in the morbidly obese: effects of computer navigation. Knee. 2011;18:108–112.PubMedCrossRefGoogle Scholar
  82. 82.
    Minoda Y, Kobayashi A, Iwaki H, Mitsuhiko I, Kadoya Y, Ohashi H, Takaoka K, Nakamura H. The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18:718–722.PubMedCrossRefGoogle Scholar
  83. 83.
    Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y. The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br. 2008;90:1025–1031.PubMedCrossRefGoogle Scholar
  84. 84.
    Molfetta L, Caldo D. Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee. 2008;15:75–79.PubMedCrossRefGoogle Scholar
  85. 85.
    Mombert M, Van Den Daelen L, Gunst P, Missinne L. Navigated total knee arthroplasty: a radiological analysis of 42 randomised cases. Acta Orthop Belg. 2007;73:49–54.PubMedGoogle Scholar
  86. 86.
    Morawa LG, Manley MT, Edidin AA, Reilly DT. Transesophageal echocardiographic monitored events during total knee arthroplasty. Clin Orthop Relat Res. 1996;331:192–198.PubMedCrossRefGoogle Scholar
  87. 87.
    National Joint Registry for England and Wales 6th Annual Report. Hemel, Hempstead, UK: NJR Centre; 2009:72.Google Scholar
  88. 88.
    Novak EJ, Silverstein MD, Bozic KJ. The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2389–2397.PubMedCrossRefGoogle Scholar
  89. 89.
    Novicoff WM, Saleh KJ, Mihalko WM, Wang XQ, Knaebel HP. Primary total knee arthroplasty: a comparison of computer-assisted and manual techniques. Instr Course Lect. 2010;59:109–17.PubMedGoogle Scholar
  90. 90.
    O’Connor MI, Brodersen MP, Feinglass NG, Leone BJ, Crook JE, Switzer BE. Fat emboli in total knee arthroplasty: a prospective randomized study of computer-assisted navigation vs standard surgical technique. J Arthroplasty. 2010;25:1034–1040.PubMedCrossRefGoogle Scholar
  91. 91.
    Oberst M, Bertsch C, Wurstlin S, Holz U. [CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study] [in German]. Unfallchirurg. 2003;106:941–948.PubMedGoogle Scholar
  92. 92.
    Ohmann C, Verde PE, Blum K, Fischer B, de Cruppé W, Geraedts M. Two short-term outcomes after instituting a national regulation regarding minimum procedural volumes for total knee replacement. J Bone Joint Surg Am. 2010;92:629–638.PubMedCrossRefGoogle Scholar
  93. 93.
    Ooi LH, Lo NN, Yeo SJ, Ong BC, Ding ZP, Lefi A. Does computer-assisted surgical navigation total knee arthroplasty reduce venous thromboembolism compared with conventional total knee arthroplasty? Singapore Med J. 2008;49:610–614.PubMedGoogle Scholar
  94. 94.
    Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computer navigated total knee arthroplasty. Knee. 2006;13:397–399.PubMedCrossRefGoogle Scholar
  95. 95.
    Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am. 2010;92:2143–2149.PubMedCrossRefGoogle Scholar
  96. 96.
    Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res. 1999;367:165–171.PubMedCrossRefGoogle Scholar
  97. 97.
    Perlick L, Bathis H, Tingart M, Perlick C, Grifka J. Navigation in total-knee arthroplasty: CT-based implantation compared with the conventional technique. Acta Orthop Scand. 2004;75:464–470.PubMedCrossRefGoogle Scholar
  98. 98.
    Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res. 1988;232:168–173.PubMedGoogle Scholar
  99. 99.
    Rauh MA, Boyle J, Mihalko WM, Phillips MJ, Bayers-Thering M, Krackow KA. Reliability of measuring long-standing lower extremity radiographs. Orthopedics. 2007;30:299–303.PubMedGoogle Scholar
  100. 100.
    Restrepo C, Hozack WJ, Orozco F, Parvizi J. Accuracy of femoral rotational alignment in total knee arthroplasty using computer assisted navigation. Comput Aided Surg. 2008;13:167–172.PubMedGoogle Scholar
  101. 101.
    Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994;299:153–156.PubMedGoogle Scholar
  102. 102.
    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRefGoogle Scholar
  103. 103.
    Schmitt J, Hauk C, Kienapfel H, Pfeiffer M, Efe T, Fuchs-Winkelmann S, Heyse TJ. Navigation of total knee arthroplasty: rotation of components and clinical results in a prospectively randomized study. BMC Musculoskelet Disord. 2011;12:16.PubMedCrossRefGoogle Scholar
  104. 104.
    Schnurr C, Csecsei G, Eysel P, Konig DP. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics. 2010;33:474.PubMedGoogle Scholar
  105. 105.
    Seon JK, Song EK. Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty. 2006;21:777–782.PubMedCrossRefGoogle Scholar
  106. 106.
    Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG. Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg. 2007;12:189–193.PubMedGoogle Scholar
  107. 107.
    Seon JK, Song EK, Yoon TR, Seo HY, Cho SG. Tibial plateau stress fracture after unicondylar knee arthroplasty using a navigation system: two case reports. Knee Surg Sports Traumatol Arthrosc. 2007;15:67–70.PubMedCrossRefGoogle Scholar
  108. 108.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.PubMedCrossRefGoogle Scholar
  109. 109.
    Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br. 2008;90:1121–1127.PubMedGoogle Scholar
  110. 110.
    Sikorski JM, Blythe MC. Learning the vagaries of computer-assisted total knee replacement. J Bone Joint Surg Br. 2005;87:903–910.PubMedGoogle Scholar
  111. 111.
    Song EK, Seon JK, Yoon TR, Park SJ, Cho SG, Yim JH. Comparative study of stability after total knee arthroplasties between navigation system and conventional techniques. J Arthroplasty. 2007;22:1107–1111.PubMedCrossRefGoogle Scholar
  112. 112.
    Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br. 2003;85:830–835.PubMedGoogle Scholar
  113. 113.
    Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ. Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br. 2007;89:477–480.PubMedCrossRefGoogle Scholar
  114. 114.
    Stiehl JB, Jackson S, Szabo A. Multi-factorial analysis of time efficiency in total knee arthroplasty. Comput Aided Surg. 2009;14:58–62.PubMedCrossRefGoogle Scholar
  115. 115.
    Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426:180–186.PubMedCrossRefGoogle Scholar
  116. 116.
    Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am. 2002;84(Suppl 2):90–98.PubMedGoogle Scholar
  117. 117.
    Stulberg SD, Yaffe MA, Koo SS. Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am. 2006;88(Suppl 4):47–54.PubMedCrossRefGoogle Scholar
  118. 118.
    Tew M, Waugh W. Estimating the survival time of knee replacement. J Bone Joint Surg Br. 1982;64:579–582.PubMedGoogle Scholar
  119. 119.
    van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, Nelissen RG. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop. 2011;35:845–850.Google Scholar
  120. 120.
    Victor J, Hoste D. Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res. 2004;428:131–139.PubMedCrossRefGoogle Scholar
  121. 121.
    Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res. 1994;299:31–43.PubMedGoogle Scholar
  122. 122.
    Watters TS, Mather RC 3rd, Browne JA, Berend KR, Lombardi AV Jr, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv. 2011;20:112–116.PubMedGoogle Scholar
  123. 123.
    Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty. 2009;24:668–673.PubMedCrossRefGoogle Scholar
  124. 124.
    Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ. Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplasty. 2008;23:462–465.PubMedCrossRefGoogle Scholar
  125. 125.
    Yaffe MA, Koo SS, Stulberg SD. Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res. 2008;466:2736–2744.PubMedCrossRefGoogle Scholar
  126. 126.
    Yang JH, Seo JG, Moon YW, Kim MH. Joint line changes after navigation-assisted mobile-bearing TKA. Orthopedics. 2009;32(Suppl):35–39.PubMedCrossRefGoogle Scholar
  127. 127.
    Zhang G, Chen J, Chai W, Liu M, Wang Y. Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures. A randomized clinical trial. J Bone Joint Surg Am. 2011;93:1190–1196.PubMedCrossRefGoogle Scholar
  128. 128.
    Zorman D, Etuin P, Jennart H, Scipioni D, Devos S. Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases. Acta Orthop Belg. 2005;71:696–702.PubMedGoogle Scholar
  129. 129.
    Zumstein MA, Frauchiger L, Wyss D, Hess R, Ballmer PM. Is restricted femoral navigation sufficient for accuracy of total knee arthroplasty? Clin Orthop Relat Res. 2006;451:80–86.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Division of Orthopaedic SurgeryUniversity of Victoria/University of British Columbia, Vancouver Island Health, Royal Jubilee HospitalVictoriaCanada
  2. 2.Department of Orthopaedic SurgeryWashington University School of MedicineSt LouisUSA

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