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Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis.
MedLine Citation:
PMID:  23340836     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Inaccurate implantation rates of up to 30 % have been reported in cases using the conventional technique for implantation of a unicompartmental knee arthroplasty. Navigation should permit a more precise implantation, and several studies have investigated its role, albeit with a limited number of patients and inconsistent results. The aim of this meta-analysis was to compare risks of unsatisfactory outcomes in patients with navigated and conventional technique. METHODS: An electronic search was performed, and ten studies were eligible and included in the meta-analysis, with a total of 258 prostheses implanted with the navigated technique and 295 with the conventional one. The following items were analysed: radiological positioning of the femoral and the tibial component in the AP and lateral view, radiological analysis of the tibiofemoral mechanical axis and the difference in operating time between the two groups. Relative risks (RR) were calculated from the reported percentages of implants outside the optimal ranges defined by the manufacturers or the study groups. Natural logarithms of the relative risks were pooled by means of random effects models. RESULTS: For all the analysed radiological parameters, the RR of measurements outside the optimal ranges were less than 1 in the navigation group suggesting a reduction in the risk of outliers with navigation. The average operating time in the navigated group was 15.4 min (95 % CI: 10.2-20.6) longer than in the conventional group. CONCLUSION: The meta-analysis shows that the use of navigation systems in UKA leads to a more precise component position. Whether the more accurate position in UKA results in a better clinical outcome or long-term survival is yet unknown. Nevertheless, as a precise implant position appears to be beneficial, the use of navigation should be recommended for UKA. The limits defined by the manufacturers for an optimal positioning are not consistent. LEVEL OF EVIDENCE: Therapeutic study (Systematic review of Level II/III studies), Level III.
Authors:
Patrick Weber; Alexander Crispin; Florian Schmidutz; Sandra Utzschneider; Matthias F Pietschmann; Volkmar Jansson; Peter E Müller
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-23
Journal Detail:
Title:  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA     Volume:  -     ISSN:  1433-7347     ISO Abbreviation:  Knee Surg Sports Traumatol Arthrosc     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9314730     Medline TA:  Knee Surg Sports Traumatol Arthrosc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Orthopedic Surgery, Ludwig-Maximilians-University, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany, Patrick.Weber@med.uni-muenchen.de.
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