Population-based Survivorship of Computer-navigated Versus Conventional Total Knee Arthroplasty

Background: The goal of computer navigation in total knee arthroplasty (TKA) is to improve the accuracy of alignment. However, the relationship between this technology and implant longevity has not been established. The purpose of this study was to analyze survivorship of computer-navigated TKAs compared with traditionally instrumented TKAs. Methods: The PearlDiver Medicare database was used to identify patients who underwent a primary TKA using conventional instrumentation versus computer navigation between 2005 and 2014. Conventional and computer-navigated cohorts were matched by age, sex, year of procedure, comorbidities, and geographic region. Kaplan-Meier curves were generated to estimate survivorship with aseptic mechanical complications, periprosthetic joint infection, and all-cause revision as end points. Results: During the study period, 75,709 patients who underwent a computer-navigated TKA were identified and matched to a cohort of 75,676 conventional TKA patients from a cohort of 1,607,803 conventional TKA patients. No difference existed in survival between conventional instrumentation (94.7%) and navigated TKAs (95.1%,P= 0.06) at 5 years. A modest decrease was found in revisions secondary to mechanical complications associated with navigation (96.1%) compared with conventional instrumentation (95.7%,P= 0.02) at 5 years. No differences in revision rates because of periprosthetic joint infection were observed (97.9% versus 97.9% event-free survival,P= 0.30). In a subgroup of Medicare patients younger than 65 years of age, use of computer navigation was associated with a decrease in all-cause revision (91.4% versus 89.6% event free survival,P= 0.01) and revision secondary to mechanical complications (89.6% versus 87.8% event-free survival,P= 0.01) at 5 years. Discussion: Among Medicare patients, no notable difference existed in TKA survival associated with the use of computer navigation at the 5-year follow-up. Use of computer navigation was associated with a slight decrease in revisions secondary to mechanical failure. Although improved survivorship was associated with patients younger than 65 years of age who had a navigated TKA, generalizability of these findings is limited given the unique characteristics of this Medicare subpopulation.