Systematic review of computer-navigated total knee arthroplasty

Conventional total knee arthroplasty (TKA) and the more recently available computer-navigated total knee arthroplasty (CNTKA) use alternative methods to achieve correct limb alignment. This systematic review was undertaken to assess the safety and effectiveness of CNTKA compared with conventional TKA.

A systematic search of multiple databases identified relevant randomized controlled trials published to August 2012. Study inclusion was established through application of a predetermined protocol, with independent assessment by two reviewers.

Thirty randomized controlled trials were included. The majority of adverse events associated with CNTKA were minor and comparable with those seen with conventional TKA. Conversion to conventional TKA was required in 1% of patients undergoing CNTKA. Thirteen trials reporting on satisfactory post-operative radiological alignment of the mechanical axis in the frontal plane were suitable for meta-analysis, which showed a significant total odds ratio (non-event) of 2.32 (95% confidence interval: 1.77-3.04) in favour of CNTKA (P < 0.00001). Clinical outcomes were comparable between the two techniques, with longer-term follow-up suggesting that CNTKA provided no benefit over conventional TKA in terms of sustained functional improvements.

At present, it is unclear whether the significant improvements shown in radiological outcomes after CNTKA translate to measurable clinical benefits. Although an assumption could be made that an improvement in post-operative alignment should lead to an improvement in patient-related outcomes, the available literature did not clearly show this. Further, long-term trials are required to address this issue.