Navigated Total Knee Replacement

Bauwens, Kai; Matthes, Gerrit; Wich, Michael; Gebhard, Florian; Hanson, Beate; Ekkernkamp, Axel; Stengel, Dirk
February 2007
Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p261
Academic Journal
Background: Proponents of navigated knee arthroplasty stress its potential to increase the precision of component placement. We conducted a systematic review and meta-analysis to substantiate the validity and relevance of this contention. Methods: We searched major medical and publishers' databases for randomized trials and any other studies comparing navigated with conventional knee arthroplasty. Major periodicals were searched manually. We made no restrictions for types of studies or language. Methodological features were rated independently by two reviewers. After testing for publication bias and heterogeneity was done, the data were aggregated by random-effects modeling. We estimated the weighted mean differences of mechanical limb axes and functional scales and the risk ratios of deviations from the straight axis with 95% confidence intervals. Results: We included thirty-three studies (eleven randomized trials) of varying methodological quality involving 3423 patients with a mean age (and standard deviation) of 67.3 ± 4.1 years (62.6% were women, and 83.7% had primary osteoarthritis). The mean preoperative deviation from the mechanical axis was 2.3° ± 5.1°. There was no evidence of publication bias, but there was strong statistical heterogeneity. The alignment of the mechanical axes did not differ between the navigated and conventional surgery group (weighted mean difference, 0.2°; 95% confidence interval, -0.2° to 0.5°). Patients managed with navigated surgery had a lower risk of malalignment at critical thresholds of >3° (risk ratio, 0.79; 95% confidence interval, 0.71 to 0.87) and >2° (risk ratio, 0.76; 95% confidence interval, 0.71 to 0.82). No conclusive inferences could be drawn on functional outcomes or complication rates. Navigation lengthened the mean duration of surgery by 23%. Conclusions: Navigated knee replacement provides few advantages over conventional surgery on the basis of radiographic end points. Its clinical benefits are unclear and remain to be defined on a larger scale.


Related Articles

  • Manipulation After Total Knee Arthroplasty. Keating, E. Michael; Ritter, Merrill A.; Harty, Leesa D.; Haas, Gail; Meding, John B.; Fans, Philip M.; Berend, Michael E. // Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p282 

    Background: Following total knee arthroplasty, some patients who fail to achieve >90° of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total...

  • Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Malviya, Ajay; Lingard, E.; Weir, D.; Deehan, D. // Knee Surgery, Sports Traumatology, Arthroscopy;Jul2009, Vol. 17 Issue 5, p491 

    We have attempted to quantify the influence of clinical, radiological and prosthetic design factors upon flexion following knee replacement. Our study examined the outcome following 101 knee replacements performed in two prospective randomized trials using similar cruciate retaining implants....

  • What is the Role of Serological Testing Between Stages of Two-stage Reconstruction of the Infected Prosthetic Knee? Kusuma, Sharat K.; Ward, Joseph; Jacofsky, Marc; Sporer, Scott M.; Valle, Craig J. Della // Clinical Orthopaedics & Related Research;Apr2011, Vol. 469 Issue 4, p1002 

    Background: Two-stage exchange arthroplasty is the gold standard for treatment of infected TKA. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count with differential are often used to determine treatment response; however, it is...

  • Sagittal laxity in vivo after total knee arthroplasty. Ishii, Yoshinori; Matsuda, Yoshikazu; Ishii, Ryo; Sakata, Shigeo; Omori, Go // Archives of Orthopaedic & Trauma Surgery;May2005, Vol. 125 Issue 4, p249 

    Introduction A stress arthrometry study of 77 knees undergoing total knee arthroplasty was performed to determine the difference in anteroposterior (AP) laxity between posterior cruciate ligament (PCL)-retaining (PCLR) and PCL-substituting (PCLS) prostheses using the Genesis I TKA. Materials and...

  • Subvastus Approach for Total Knee Arthroplasty. Gore, Donald R.; Sellinger, D. Scott; Gassner, Kevin J.; Glaeser, Scott T. // Orthopedics;Jan2003, Vol. 26 Issue 1, p33 

    Provides information on a study that described and illustrated the steps in the subvastus approach to total knee arthroplasty. Reason the approach has been criticized; Methodology of the study; Discussion of the study.

  • Total Knee Arthroplasty With Modular Rotating-platform Hinge. Jones, Richard E. // Orthopedics;Sep2006 Supplement, Vol. 29, pS80 

    Third-generation modular rotating hinged knee systems are now widely available. The S-ROM rotating hinge features slotted and splined stems for torsional stability, and metaphyseal filling and loading sleeves for the bony defects encountered in revision total knee arthroplasty (TKA). Primary...

  • Tibial Post Impingement in Posterior-stabilized Total Knee Arthroplasty. Haas, Brian D. // Orthopedics;Sep2006 Supplement, Vol. 29, pS83 

    Posterior-stabilized total knee arthroplasty (TKA) has enjoyed documented long-term success. Few complications related to tibial post failure have been documented. Impingement between the tibial post and femur has been implicated in failure and increased wear. Issues of surgeon component...

  • Low Contact Stress (LCS) Complete Knee System in Revision Surgery. Lippe, Craig N.; Crossett, Lawrence S. // Orthopedics;Sep2006 Supplement, Vol. 29, pS86 

    Revision total knee arthroplasty (TKA) should offer the same benefits to patients as primary TKA. As in primary TKA, a main objective of revision TKA is to reduce pain and restore functional range of motion. There are several potential causes of total knee failure, but the principles of...

  • Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Dae-Hee Lee; Jong-Hoon Park; Dong-Ik Song; Debabrata Padhy; Woong-Kyo Jeong; Seung-Beom Han // Knee Surgery, Sports Traumatology, Arthroscopy;Mar2010, Vol. 18 Issue 3, p381 

    Equalized rectangular extension and flexion gaps are considered desirable to ensure proper kinematics in total knee arthroplasty (TKA). We compared soft tissue balancing in TKAs performed using navigation-assisted gap-balancing (60 knees) and conventional measured resection (56 knees). The...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics