Objective To evaluate the radiographic and postoperative function of computer navigation versus traditional methods for total knee arthroplasty through meta-analysis.
Methods we searched the specialized trials registered in Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2009), EMbase (1980 to 2009), PubMed (1966 to 2009), NRR (http://www.update-software.com/National/), CCT (http://www.controlled-trials.com), and CBMdisc (1979 to July 2009), and we manually searched some Chinese orthoopaedics journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials of computer navigation and traditional methods for total knee arthroplasty were included. The quality of the included trials was critically assessed. RevMan 4.2.8 software was used for data analysis.
Results Eighteen RCTs of computer navigation and traditional methods for total knee arthroplasty were included. A total of 2 349 patients met the inclusion criteria for the review. The results showed that, computer navigation versus traditional methods for the total knee arthroplasty: a) about radiography: there was difference in the precise measurement of lower limbs mechanical axis (WMD= – 0.56, 95%CI – 0.74 to – 0.38, P lt;0.00001), but no obvious difference in measurement of the femoral frontal axis (WMD= – 0.29, 95%CI – 0.58 to 0.00, P=0.05), sagittal axis (WMD= – 1.64, 95%CI – 3.49 to 0.21, P=0.08) and angle of rotation (WMD= – 0.11, 95%CI – 0.87 to 0.66, P=0.79). Obvious difference was not found in the tibial frontal axis (WMD= – 0.31, 95%CI – 0.69 to 0.06, P=0.10), but found in the tibial sagittal axis (WMD= – 0.69, 95%CI – 1.10 to – 0.28, P=0.001). No difference was found in the tibiafemoral angle (WMD= 0.03, 95%CI – 0.78 to 0.84, P=0.95), patella tilt angle (WMD= – 1.45, 95%CI – 3.12 to 0.22, P=0.09) and patella angle of rotation (WMD= – 0.34, 95%CI – 0.71 to 0.02, P=0.06); b) there was obvious difference in operating time (WMD= 13.31, 95%CI 10.00 to 16.63, P lt;0.000 01), but no obvious difference in the complications (RR= 1.65, 95%CI 0.87 to 3.13, P=0.13) and the hemorrhage volume (WMD= – 74.81, 95%CI – 184.71 to 35.09, P=0.18); and c) about the evaluation of postoperative function: the follow-up in all studies was more than 6 months; there was no obvious difference in joint motion (WMD= – 2.17, 95%CI – 5.66 to 1.33, P=0.22), KSS scores (WMD= 6.28, 95%CI – 3.69 to 16.25, P=0.22), and OXFORD scores (WMD= – 0.31, 95%CI – 2.05 to 1.43, P=0.72).
Conclusions Compared with traditional methods, computer navigation using for the total knee arthroplasty: a) is much accurate in measurement of the lower limbs mechanical axis and tibial sagittal axis, but is not superior in measurement of the femoral frontal axis, femoral sagittal axis, femoral angle of rotation, tibial frontal axis, tibiafemoral angle, patella tilt angle, and patella angle of rotation; b) may spend a longer operating time if not performed by proficient for it is a kind of new technique realm, but is similar in decreasing complications and hemorrhage volume; and c) is not obvious different in function evaluation after over 6 months follow-up which has to be further studied.
Citation： LI Bin,WARESIJIANGNiyazi,ZHAO Xibin,WANG Li,SUN Jungang,YUAN Hong. Comparison of Computer Navigation and Traditional Method for Total Knee Arthroplasty Implant Placement: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(11): 1259-1268. doi: 10.7507/1672-2531.20100582 Copy