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Computer Navigation-Assisted Knee Replacement Demonstrates Improved Outcome Compared with Conventional Knee Replacement at Mid-Term Follow-up: A Systematic Review and Meta-analysis

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Abstract

The study is a systematic review and meta-analysis of prospective randomised control studies and prospective cohort studies of mid-term functional outcome of total knee replacement undertaken using imageless computer navigation compared with conventional instrumented total knee replacement. The literature search strategy included a search of the electronic databases, visual scanning of reference lists, hand searching of key journals and conference proceedings, and abstracts, citations, and trial registers. In total, 440 papers were retrieved after removal of duplicates, and with further screening, 11 papers were included in the systematic review and 6 papers were considered appropriate for meta-analysis. Analysis of the data showed evidence of a modest improvement in functional outcome at mid-term follow-up with use of imageless computer navigation assistance compared with conventional instrumented total knee replacement with a total score point estimate of 3.36 confidence interval (CI) (− 0.583, 7.298), objective score point estimate of 1.45 CI (0.11, 2.799), and functional score point estimate of 2.4, CI (− 1.174, 5.977). The predominant risk of bias was from random allocation and attrition. There is evidence of a modest improvement in functional outcome with the use of imageless computer navigation assistance compared with conventional instrumented total knee replacement at mid-term follow-up.

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References

  1. Pradhan, N. R., Gambhir, A., & Porter, M. L. (2006). Survivorship analysis of 3234 primary knee arthroplasties implanted over a 26-year period: a study of eight different implant designs. The Knee, 13, 7–11.

    Article  CAS  PubMed  Google Scholar 

  2. Robertsson, O., Dunbar, M., Pehrsson, T., Knutson, K., & Lidgren, L. (2000). Patient satisfaction after knee arthroplasty: A report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthopaedica Scandinavica, 71, 262–267.

    Article  CAS  PubMed  Google Scholar 

  3. Shakespeare, D. (2006). Conventional instruments in total knee replacement: What should we do with them? The Knee, 13, 1–6.

    Article  PubMed  Google Scholar 

  4. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). (2018). Hip, Knee and Shoulder Arthroplasty: 2018 Annual Report. Adelaide: AOA.

    Google Scholar 

  5. Bourne, R. B., Chesworth, B. M., Davis, A. M., Mahomed, N. N., & Charron, K. D. (2010). Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clinical Orthopaedics and Related Research, 468, 57–63.

    Article  PubMed  Google Scholar 

  6. Mason, J. B., Fehring, T. K., Estok, R., Banel, D., & Fahrbach, K. (2007). Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. Journal of Arthroplasty, 22, 1097–1106.

    Article  PubMed  Google Scholar 

  7. Blakeney, W. G., Khan, R. J., & Wall, S. J. (2011). Computer- assisted techniques versus conventional guides for comparing component alignment in total knee arthroplasty: A randomised control trial. Journal of Bone and Joint Surgery. American Volume, 93, 1377–1384.

    Article  PubMed  Google Scholar 

  8. Rebal, B. A., Babatunde, O. M., Lee, J. H., Geller, J. A., Patrick, D. A., Jr., & Macaulay, W. (2014). Imageless computer navigation in total knee arthroplasty provides superior short-term functional outcomes: A meta-Analysis. Journal of Arthroplasty, 29, 938–944.

    Article  PubMed  Google Scholar 

  9. Burnett, R. S., & Barrack, R. L. (2013). Computer-assisted Total Knee Arthroplasty is currently of no proven clinical benefit: A systematic review. Clinical Orthopaedics and Related Research, 471(1), 264–276.

    Article  PubMed  Google Scholar 

  10. Hetaimish, B. M., Khan, M. M., Simunovic, N., Al-Harbi, H. H., Bhandari, M., & Zalzal, P. K. (2012). Meta-analysis of navigation vs conventional total knee arthroplasty. Journal of Arthroplasty, 27, 1177–1182.

    Article  PubMed  Google Scholar 

  11. Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group. (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8, 18.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., et al. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Core Team, R. (2013). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.

    Google Scholar 

  14. Guido Schwarzer. meta: General Package for Meta-Analysis, 2015. R package version 4.1–0.

  15. Huang, N. F. R., Dowsey, M. M., Eric, E. E., Stoney, J. D., Babazadeh, S., & Choong, P. F. (2012). Coronal alignment correlates with outcome after total knee arthroplasty: Five- year follow-up of a randomised controlled trial. Journal of Arthroplasty, 27, 1737–1741.

    Article  PubMed  Google Scholar 

  16. Yaffe, M., Chan, P., Goyal, N., Luo, M., Cayo, M., & Stulberg, S. D. (2013). Computer-assisted versus manual TKA: Outcomes at 5-year follow-up. Orthopaedics, 36, e629–e632.

    Article  Google Scholar 

  17. Blakeney, W. G., Khan, R. J. K., & Palmar, J. L. (2014). Functional outcome following total knee arthroplasty: A randomised trial comparing computer-assisted surgery with conventional techniques. The Knee, 21, 364–368.

    Article  PubMed  Google Scholar 

  18. Cip, J., Widemschek, M., Luegmair, M., Sheinkop, M. B., & Benesch, T. (2014). Conventaional versus computer-assisted technique for total knee arthroplasty: A minimum of 5-year follow-up of 200 patients in a prospective randomized comparative trial. Journal of Arthroplasty, 29, 1795–1802.

    Article  PubMed  Google Scholar 

  19. Kim, Y. H., Park, J. W., & Kim, J. S. (2012). Computer-navigated versus conventional total knee arthroplasty a prospective randomized trial. Journal of Bone and Joint Surgery. American Volume, 94, 2017–2024.

    Article  PubMed  Google Scholar 

  20. Hoffart, H. E., Langenstein, E., & Vasak, N. (2012). A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement. Journal of Bone and Joint Surgery. British Volume, 94, 194–199.

    Article  PubMed  Google Scholar 

  21. Thiengwittayaporn, S., Kanjanapiboonwong, A., & Junsee, D. (2013). Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty. Journal of Orthopaedic Surgery and Research, 8(1), 37.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Harvie, P., Sloan, K., & Beaver, R. J. (2012). Computer navigation vs conventional total knee arthroplasty: Five-year functional results of a prospective randomized trial. Journal of Arthroplasty, 27, 667–672.

    Article  PubMed  Google Scholar 

  23. Hoppe, S., Mainzer, J. D., Frauchiger, L., Ballmer, P. M., Hess, R., & Zumstein, M. A. (2012). More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up. Acta Orthopaedica, 83, 629–633.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Allen, C. L., Hooper, G. J., Oram, B. J., & Wells, J. E. (2014). Does computer-assisted total knee arthroplasty improve component position and patient function. International Orthopaedics, 38, 251–257.

    Article  PubMed  Google Scholar 

  25. Lutzner, J., Dexel, J., & Kirschner, S. (2013). No difference between computer-assisted and conventional total knee arthroplasty: Five year result of a prospective randomised study. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 2241–2247.

    Article  PubMed  Google Scholar 

  26. Ritter, M. A., Davis, K. E., Meding, J. B., Pierson, J. L., Berend, M. E., & Malinzak, R. A. (2011). The effect of alignment and BMI on failure of total knee replacement. Journal of Bone and Joint Surgery. American Volume, 93, 1588–1596.

    Article  PubMed  Google Scholar 

  27. Jeffrey, R. S., Morris, R. W., & Denham, R. A. (1991). Coronal alignment after total knee replacement. Journal of Bone and Joint Surgery. British Volume, 73, 709–714.

    Article  Google Scholar 

  28. Y.-H., Kim, J.-W., Park, J.-S. Kim. Computer-navigated versus conventional total knee arthroplasty: A prospective randomized trialThe Journal of Bone and Joint Surgery (Aamerican), 2012.

  29. Xie, C., Liu, K., Xiao, L., & Tang, R. (2012). Clinical outcomes after computer-assisted versus conventional total knee arthroplasty. Orthopaedics, 35(5), e647–e653.

    Article  Google Scholar 

  30. Lehnen, K., Giesinger, K., Warschkow, R., Porter, M., Koch, E., & Kuster, M. S. (2011). Clinical outcome using a ligament referencing technique in CAS versus conventional technique. Knee Surgery, Sports Traumatology, Arthroscopy, 19, 887–892.

    Article  CAS  PubMed  Google Scholar 

  31. Parvizi, J., Nunley, R. M, Berend, K. R, et al. (2014). High level of residual symptoms in young patients after total knee arthroplasty. Clinical Orthopaedics and Related Research, 472(1), 133–137. https://doi.org/10.1007/s11999-013-3229-7.

    Article  PubMed  Google Scholar 

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All the authors (CA, ON, and TA) contributed to the literature search and selection of the review papers. CA and TA contributed to data extraction. CA and ON contributed to writing the paper. CA, ON, and TA contributed to proof reading the paper. We confirm that all authors have read and approved the manuscript, and agreed to its submission.

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Correspondence to Charles Ayekoloye.

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Ayekoloye, C., Nwangwu, O. & Alonge, T. Computer Navigation-Assisted Knee Replacement Demonstrates Improved Outcome Compared with Conventional Knee Replacement at Mid-Term Follow-up: A Systematic Review and Meta-analysis. JOIO 54, 757–766 (2020). https://doi.org/10.1007/s43465-020-00161-z

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Keywords

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