Current concepts and future perspectives in computer-assisted navigated total knee replacement.

Abstract

BACKGROUND: Total knee replacements (TKR) aim to restore stability of the tibiofemoral and patella-femoral joints and provide relief of pain and improved quality of life for the patient. In recent years, computer-assisted navigation systems have been developed with the aim of reducing human error in joint alignment and improving patient outcomes. METHODS: We examined the current body of evidence surrounding the use of navigation systems and discussed their current and future role in TKR. RESULTS: The current body of evidence shows that the use of computer navigation systems for TKR significantly reduces outliers in the mechanical axis and coronal prosthetic position. Also, navigation systems offer an objective assessment of soft tissue balancing that had previously not been available. Although these benefits represent a technical superiority to conventional TKR techniques, there is limited evidence to show long-term clinical benefit with the use of navigation systems, with only a small number of studies showing improvement in outcome scores at short-term follow-up. Because of the increased costs and operative time associated with their use as well as the emergence of more affordable and patient-specific technologies, it is unlikely for navigation systems to become more widely used in the near future. CONCLUSIONS: Whilst this technology helps surgeons to achieve improved component positioning, it is important to consider the clinical and functional implications, as well as the added costs and potential learning curve associated with adopting new technology.