Purpose

Accurate implant position in total knee arthroplasty (TKA) can potentially lead to better long-term functional outcomes and implant survival. Recent studies on whether better clinical results could be obtained from computer-navigated or conventional TKA were inconclusive. In addition, recent reviews only included short-term follow-up studies without performing quantitative mid- to long-term follow-up analysis. Thus, the purpose of the present study was to perform a meta-analysis comparing mid- to long-term clinical outcomes (such as knee scoring and functional results) and radiological outcomes (such as normal alignment of the limb axis or component) between computer-navigated TKA and conventional TKA to determine which method of TKA could obtain better clinical and radiological results.

Methods

MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases were searched for relevant articles published through August 2018 that compared outcomes of computer-navigated TKA and conventional TKA. Data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. Clinical and radiological outcomes of both techniques were evaluated using various outcome measures.

Results

Seven randomized controlled trials were included. Based on Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, pain, and range of motion, there were no significant differences in clinical outcomes between the two techniques. Based on outliers from the normal axis, outliers of femoral components in the coronal plane, and outliers of tibial components in the coronal plane, radiologic outcomes showed no significant differences between the two techniques either.

Conclusions

The present study revealed that there were no significant differences in clinical or radiological outcomes between computer-navigated TKA and conventional TKA. It remains unclear which TKA technique yields better results in terms of mid- to long-term clinical and radiological outcomes.

Level of evidence

I.

中文翻译：

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与传统的全膝关节置换术相比，计算机辅助导航的中长期疗效无差异。

目的

全膝关节置换术（TKA）中正确的植入物位置可能会导致更好的长期功能结局和植入物存活。从计算机导航或常规TKA是否可获得更好的临床结果的最新研究尚无定论。此外，最近的评论仅包括短期随访研究，而没有进行定量的中长期随访分析。因此，本研究的目的是对计算机之间的中长期临床结果（例如膝关节评分和功能结果）和放射学结果（例如肢体轴或组件的正常对齐）进行荟萃分析。导航TKA和常规TKA，以确定哪种TKA方法可以获得更好的临床和放射学结果。

方法

搜索MEDLINE，EMBASE，Cochrane对照试验中央注册系统（CENTRAL），Web of Science和SCOPUS电子数据库，以搜索截至2018年8月发表的相关文章，以比较计算机导航的TKA和常规TKA的结果。数据搜索，提取，分析和质量评估均根据Cochrane协作指南进行。两种技术的临床和放射学结局均使用各种结局指标进行评估。

结果

包括七项随机对照试验。根据膝关节社会评分，西安大略大学和麦克马斯特大学的骨关节炎指数，疼痛和运动范围，两种技术在临床结局方面无显着差异。根据法线的异常值，冠状平面的股骨成分的异常值和冠状平面的胫骨成分的异常值，放射学结果在两种技术之间均无显着差异。

结论

本研究表明，计算机导航的TKA与常规TKA在临床或放射学结局方面无显着差异。尚不清楚哪种TKA技术在中长期临床和放射学结果方面能产生更好的结果。

证据水平

一世。