[Future implications of navigation in total knee arthroplasty]

Area of Science:

• Orthopedic Surgery
• Medical Technology Evaluation

Background:

• Computer-assisted knee arthroplasty (CAKA) has over two decades of data, demonstrating excellent implant positioning and long-leg axis reconstruction.
• CAKA is considered the gold standard for precise total knee component alignment, accommodating various alignment strategies.
• While previous studies showed no significant functional outcome differences, recent meta-analyses highlight CAKA's advantages, possibly due to software advancements in soft tissue balancing and improved follow-up assessments.

Purpose of the Study:

• To evaluate the established benefits and current standing of computer-assisted knee arthroplasty.
• To compare computer-assisted knee arthroplasty with emerging robotic-assisted techniques.

Main Methods:

• Review of extensive study data and international registry analyses spanning over two decades.
• Analysis of long-term outcomes, including revision rates for aseptic loosening and osteolysis.
• Comparison of computer-assisted knee arthroplasty with newer robotic-assisted knee arthroplasty technologies.

Main Results:

• CAKA demonstrates significant advantages in implant positioning and long-leg axis reconstruction.
• International registries report lower revision rates for CAKA due to aseptic loosening/osteolysis, with benefits observed as early as six months post-surgery.
• Despite benefits, CAKA is not yet standard practice, with significant regional variations in use.

Conclusions:

• Computer-assisted knee arthroplasty offers proven benefits in precision and long-term outcomes.
• Newer robotic-assisted knee arthroplasty must demonstrate clear advantages to justify its higher costs compared to established CAKA.
• The widespread adoption of CAKA remains a challenge, despite its established efficacy.