Updates on Computer-Assisted Navigation in Unicompartmental Knee Arthroplasty (UKA) and Total Knee Arthroplasty (TKA)

Abstract

Computer-assisted surgery was first developed in the early twentieth century and has evolved since to find widespread application in the field of knee arthroplasty, especially in the last two decades. The objective of computer-assisted orthopedic surgery (CAOS) in knee arthroplasty is to provide surgeons with a tool to attain greater accuracy and precision of component positioning, to ultimately allow for consistent and reproducible restoration of limb alignment. In this chapter, we describe the three broad categories of CAOS—image-based, imageless, and handheld—along with their technological bases. A review of the clinical outcomes of CAOS in unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) is also provided, utilizing studies performed over the last decade. To date, the preponderance of studies have consistently demonstrated a lack of superiority with respect to clinical outcomes and survivorship of CAOS technology over conventional UKA and TKA. The cost of institutional adoption of CAOS technology is quite substantial and its introduction to the operating room workflow adds to operating room time—these two factors, along with the demonstrated lack of clinical outcome superiority have led to lackluster adoption of the technology on a large scale, especially in the United States. Although CAOS has reached maturity in its technological capacity, active efforts are being undertaken by industry to more efficiently and seamlessly integrate the technology into practice settings. More studies on CAOS on UKA and TKA will continue to be published in the coming years and decades; the findings from these studies will be influential in the trend of adoption of CAOS.