Sunday, November 25, 2012

Computer-Navigated Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Trial JBJS

Computer-Navigated Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Trial JBJS

This is a remarkable study: a single surgeon, prospective randomized trial of conventional versus computer navigated total knee arthroplasty - all 520 patients had one of each - the average followup of over 10 years. The bottom line is that there were no differences in clinical or radiographic outcome between the two approaches. The computer assisted knees had 16% longer OR times and 40% longer tourniquet times.

8 knees with the computer-navigated technique and four knees with the conventional technique were revised as a result of aseptic loosening of the femoral component. Twenty-six knees  had anterior femoral notching in the navigation group and six in the conventional group. Five knees in the navigation group had excessive resection of the tibia. Both infections were in the navigation group.

The only shortcoming is that, aside from the surgical times, we were not provided with the incremental costs of computer navigation. Even without these data, this study did not establish value of computer navigation in knee arthroplasty.

There has been some interest in computer navigation in shoulder arthroplasty with studies showing its value in vitro, however, we suspect that clinical studies are likely to yield the same result as the current study regarding total knee. In some respects, shoulder arthroplasty may be even more challenging: the errors made in the total knee series reported here were attributed to 'registration errors', that is failure to properly align the navigation system - the deep location of the glenohumeral joint may make this even more difficult in the shoulder.

Unless the value of computer navigation can be robustly demonstrated in clinical practice, we must question if this is a way that we wish to spend our precious health care dollars.


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