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Does Accelerometer-based Navigation Have Any Clinical Benefit Compared with Conventional TKA? A Systematic Review.

Nicolaas C Budhiparama1, Imelda Lumban-Gaol, Nadia N Ifran

  • 1N. C. Budhiparama, I. Lumban-Gaol, N. N. Ifran, Nicolaas Institute of Constructive Orthopaedic Research & Education Foundation for Arthroplasty & Sports Medicine at Medistra Hospital, Jakarta, Indonesia S. Parratte, Institute for Locomotion, Sainte Marguerite Hospital, Aix-Marseille University, Marseille, France R. Nelissen, Leiden University Medical Center, Leiden, The Netherlands.

Clinical Orthopaedics and Related Research
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Accelerometer-based navigation for total knee arthroplasty (TKA) shows no clear benefits in accuracy or patient outcomes compared to conventional TKA. Evidence suggests it may increase surgical time without reducing complications, warranting caution in adoption.

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Area of Science:

  • Orthopedic Surgery
  • Medical Technology Evaluation
  • Surgical Navigation Systems

Background:

  • Accelerometer-based navigation offers a simpler alternative to computer-assisted surgery (CAS) for total knee arthroplasty (TKA).
  • Evaluating the clinical benefits of accelerometer-based navigation compared to conventional TKA is crucial due to its increasing adoption.

Purpose of the Study:

  • To determine if accelerometer-based navigation is more accurate than conventional TKA.
  • To assess if accelerometer-based navigation improves functional outcomes.
  • To compare surgical time, complication rates, and reoperation risks between accelerometer-based navigation and conventional TKA.

Main Methods:

  • Systematic review of prospective and retrospective comparative studies from MEDLINE/PubMed and Cochrane libraries (last 10 years).
  • Inclusion of 11 studies (621 knees for accelerometer-based navigation, 677 for conventional TKA) in English.
  • Assessment of alignment, functional scores, surgical duration, complications, and reoperations, with quality evaluation using MINORS and Cochrane Risk of Bias tools.

Main Results:

  • Inconsistent evidence regarding mechanical axis and tibial component alignment, with most studies showing no significant difference between groups.
  • No demonstrated difference in functional outcomes, range of motion, or patient-reported outcomes.
  • No significant difference in surgical time or complication/reoperation rates, though one study noted a slight increase in surgical time with accelerometer-based navigation.

Conclusions:

  • Conflicting evidence exists on whether accelerometer-based navigation improves alignment or reduces outliers.
  • No evidence supports improved patient outcomes or reduced complications/reoperations; surgical time may increase.
  • Low overall evidence quality suggests potential overestimation of benefits; widespread adoption is not recommended without higher-quality evidence.