Computer-Assisted Surgery versus Manual Total Knee Arthroplasty: A Case-Controlled Study

Abstract

The use of computer-assisted surgery by orthopaedists experienced in the performance of total knee arthroplasty results in better overall limb and implant alignment and fewer outliers as compared with the findings after manual total knee arthroplasty1-8. However, we are not aware of any studies that have established whether these improvements in alignment accuracy are associated with superior clinical and patient-perceived functional results. In addition, we are not aware of any studies that have examined the potential training effects that occur when experienced surgeons use these techniques. Computer-assisted surgery may offer experienced surgeons the potential to improve their technique and their ability to perform total knee arthroplasty manually through intraoperative training effects provided by working with computer-assisted surgery. For example, in severely obese patients, proper limb alignment may not be readily apparent on initial visualization or with use of a standard mechanical alignment system. However, through the use of a navigation system, it is possible to obtain real-time alignment measurements during the course of the surgical procedure. The intraoperative feedback provided by the navigation system offers the surgeon the ability to adjust his or her perception and assessment of proper limb and implant alignment. This training effect may result in a more accurate total knee arthroplasty performed with use of manual instrumentation. The first goal of the present study was to compare the clinical, patient-perceived functional, and radiographic results of manually performed total knee arthroplasty with the results obtained with use of computer-assisted surgery techniques. The second goal was to assess the impact of extensive experience with computer-assisted surgery on the manual technique of an experienced total knee arthroplasty surgeon. Seventy-eight consecutive total knee arthroplasties were performed by a single surgeon (S.D.S.) who had extensive prior experience with both computer-assisted surgery and manual total knee arthroplasty. Of …