The Computer Is Only a Tool and Not an Outcome

Abstract

To the ongoing debates in total knee arthroplasty on whether to use cemented or cementless fixation, whether to preserve or replace the posterior cruciate ligament, whether or not to resurface the patella, and, more recently, what is the appropriate alignment of a total knee replacement (mechanical or “kinematic”), we now add whether the use of computer navigation in total knee arthroplasty will alter the outcome of the surgery. The article by Kim and colleagues in this issue of The Journal of Bone and Joint Surgery (American Volume) provides midterm clues, yet raises several important questions. The seminal issue raised by this paper is one that requires further examination: Are we asking the correct questions when we assess the effect of computer navigation on the outcome of a surgical procedure? In their prospective randomized trial, Kim et al. reported the results of 520 patients who underwent bilateral total knee arthroplasty performed sequentially during the same anesthetic session by a single experienced surgeon. The patients were randomly assigned to undergo either total knee arthroplasty with the use of conventional guides or computer-navigated total knee arthroplasty on the first limb, followed by the opposite approach on the contralateral limb. The authors posed three study questions: (1) Was clinical function improved in the computer-navigated surgery group? (2) Did computer-navigated surgery improve alignment and, …