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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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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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