Abstract
Modern total knee arthroplasty is effective at treating the pain and disability associated with osteoarthritis. The number of total knee replacements done in the USA continues to increase. Despite the great care taken during all of these procedures, some patients remain dissatisfied with their outcome. While this dissatisfaction is likely multifactorial, malalignment of the prosthetic components is a major cause of postoperative complications. A neutral mechanical axis plus or minus 3° is felt to have a positive impact on the survivorship of the prosthesis. Conventional instrumentation has been shown to have a significant number of total knee replacements that lie well outside a neutral coronal alignment. With that in mind, significant effort has been placed into the development of technology to improve the overall alignment of the prosthesis. In order to reduce the number of outliers, several companies have developed cost-effective systems to aid the surgeon in achieving a more predictably aligned prosthesis in all three planes. We will review the literature that is available regarding several of these tools to examine if navigation or custom guides improve outcomes in total knee arthroplasty. Our review supports that while both navigation and custom implants guides seem to be a cost effective way to achieve a predictable mechanical alignment of a total knee prosthesis therefore reducing the number of outliers, the cost may be increased operative times with no perceived difference in patient satisfaction with navigation custom guides.
Highlights
Osteoarthritis of the knee is among the most common contributing causes of global disability, prevalent in as much as 20 to 40 % of those over 75 years of age [1, 2]
This review aims to highlight the current literature surrounding navigation and custom implants in total knee arthroplasty, in particular the effect on perioperative, radiographic, and clinical outcomes, to determine the role these new technologies may have in improving the patient experience with Total knee arthroplasty (TKA)
For mechanical alignment this study found a malalignment of greater than 3° which occurred in only 9.0 % of patients in the CAS group versus 31.8 % of patients in the conventional TKA group
Summary
Osteoarthritis of the knee is among the most common contributing causes of global disability, prevalent in as much as 20 to 40 % of those over 75 years of age [1, 2]. Total knee arthroplasty (TKA) has revolutionized the quality of life for millions of patients and has proven to be a cost-effective and reliable treatment for symptomatic osteoarthritis of the knee. An estimated 700,000 TKAs are performed in the USA each year, making it one of the most common procedures annually performed, with a projected increase in demand to over 3.48 million procedures by 2030 [3,4,5]. As such, achieving as close to neutral mechanical alignment in the coronal plane remains the gold standard goal for implant positioning. Drawbacks to conventional alignment systems include difficulty with identifying anatomic landmarks intraoperatively as well as the assumption of standard anatomic relationships, which may not always be consistent across all patients
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