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A Meta-Analysis Comparing Accelerometer-Based Portable Navigation Systems and Traditional Techniques in Total Knee
Zhiyong Tang1, Mu Yuan1, Lijuan Jiang2
1Department of Hyperbaric Oxygen, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China.
Background:
Accelerometer-based portable navigation (ABN) systems have been widely applied in total knee arthroplasty (TKA). However, their accuracy versus traditional techniques remains debated. Since previous meta-analyses have reported inconsistent results, a high-quality meta-analysis is required to compare radiological and functional outcomes of TKA with ABN versus conventional techniques.
Methods:
Following Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, randomized controlled trials were retrieved from multiple databases. Outcomes included mechanical axis (MA), coronal femoral angle (CFA), coronal tibial angle (CTA), outliers, operation duration, blood loss, Knee Society Score, and Knee Function Score. A total of nine studies involving 956 knees were included in this meta-analysis.
Results:
The postoperative MA accuracy in the ABN group was significantly better than that in the conventional group [mean difference (MD) = -0.78, 95% confidence interval (CI) (-0.94 to -0.62), P < 0.00001]. The proportion of MA outliers was 9.6 in the ABN group versus 23.7% in the conventional group, suggesting that ABN may be associated with a lower incidence of MA outliers. Compared with conventional techniques, ABN was associated with improved CFA accuracy [MD = -0.56, 95% CI (-0.69 to -0.43), P < 0.00001] and also showed improved CTA accuracy [MD = -0.31, 95% CI (-0.58 to 0.03), P = 0.03]. Meanwhile, ABN reduced the risk of CFA outliers [relative risk = 0.22, 95% CI (0.12 to 0.40), P < 0.00001] and the risk of CTA outliers [relative risk = 0.48, 95% CI (0.28 to 0.81), P = 0.006]. There were no significant differences found in blood loss, operation duration, (Knee Society Score, or Knee Function Score.
Conclusions:
The ABN-assisted TKA enhances lower extremity alignment accuracy without prolonging operation time, but shows no beneficial effects on functional outcomes at a mean follow-up of six months.
Level Of Evidence:
Level II; Systematic review and meta-analysis of heterogeneous level I randomized controlled trials.