Computer-Assisted Surgical Navigation Does Not Improve the Alignment and Orientation of the Components in Total Knee Arthroplasty

Background: Whether total knee arthroplasty with use of computer-assisted surgical navigation can improve the limb and component alignment is a matter of debate. We hypothesized that total knee arthroplasty with use of computer-assisted surgical navigation is superior to conventional total knee arthroplasty with regard to the precision of implant positioning. Methods: Sequential simultaneous bilateral total knee arthroplasties were carried out in 160 patients (320 knees). One knee was replaced with use of a computer-assisted surgical navigation system, and the other was replaced conventionally without use of computer-assisted surgical navigation. The two methods were compared for accuracy of orientation and alignment of the components as determined by radiographs and computed tomography scans. The mean duration of follow-up was 3.4 years. Results: The mean preoperative Knee Society score was 26 points, with an improvement to 92 points postoperatively, in the computer-assisted total knee arthroplasty group and 25 points, with an improvement to 93 points postoperatively, in the conventional total knee arthroplasty group. Preoperative and postoperative ranges of motion of the knees were similar in both groups. The operating and tourniquet times were significantly longer in the computer-assisted total knee arthroplasty group than in the conventional total knee arthroplasty group (p < 0.001). The groups were not significantly different with regard to the accuracy of component positioning and the number of outliers for the various radiographic parameters (p > 0.05). Conclusions: Our data demonstrate that total knee arthroplasty with use of computer-assisted surgical navigation did not result in more accurate implant positioning than that achieved in conventional total knee arthroplasty, as determined by both radiographs and computed tomography scans.