Continued Evidence for Improved Outcomes in Navigated Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures worldwide. The goal is to correct axial misalignment, restore functionality and maximize mobility to increase long-term survival of the implant while relieving pain and improving quality of life for the patient. Using state-of-the-art technology to improve patient outcome is an important part of many operating rooms and daily routines. That’s why nowadays many surgeons are using orthopedic surgical navigation that has been shown to improve alignment [1], reduce revisions [2] and improve functional outcomes [3] in TKA.

Evidence for this is provided by the results of the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) Annual Report.

The AOA NJRR is the largest registry for total knee replacement procedures with about 600,000 total knee replacements to date, tracked over a period of up to 16 years. An analysis of data from 2003 to 2012 concludes that “computer navigation reduced the overall rate of revision and the rate revision for loosening/-lysis following total knee arthroplasty in patients less than sixty-five years of age” [2]. This trend is continuing and has now been proven in the 2018 AOA NJRR with significant “reduction in the rate of revision for navigated knee replacement for loosening in both age groups” [4].

The risk for revision in particular in the younger patient population (under 65 years) reduced by more than one third (HR = 0.65 (0.57, 0.73), p<0.001) and by more than one quarter (HR = 0.72 (0.63, 0.81), p<0.001) in the remaining older and less active patients.

At the same time, the percentage of total knee replacement procedures performed with computer navigation in Australia has been significantly increasing since first introduced in 2001. By 2017, computer navigation was used in 33.6% of all primary total knee replacement procedures in Australia [4].

Dr. Kaushik Hazratwala from Townsville, Australia, was an early adopter and has over a decade’s experience with computer navigation in TKA. Dr. Hazratwala can see this trend in his daily clinical work and knee cases:

“I have been using navigation for over 10 years now and meanwhile for all my knee cases. In my practice, I have recorded better patient outcomes and a lower revision rate. Navigation has made me a much better knee surgeon. It is a tool for surgeons to improve patient outcomes by limiting the outlier errors that inherently cannot be avoided by using conventional instruments.

I am a power user of the new Brainlab KNEE3 Navigation Software that has simplified navigation for newcomers and users of traditional CAS (computer-assisted surgery) knee replacement. It allows the surgeon to graphically assess the impact of bone cut alteration before the saw is even touched and to navigate resection to 1 mm accuracy to suit the knee’s soft tissue envelope – thus limiting soft tissue release.” [2] [6]

Watch Dr. Hazratwala’s interview here to learn more about navigated TKA.

References
[1] Mason JB, Fehring TK, Estok R, et al. Meta-Analysis of Alignment Outcomes in Computer-Assisted Total Knee Arthroplasty Surgery. J Arthroplasty Volume 22 (8), pp. 1097-1106, 2007.
[2] Steiger RN de, Liu YL, Graves SE. Computer Navigation for Total Knee Arthroplasty Reduces Revision Rate for Patients Less Than Sixty-five Years of Age. In The Journal of Bone and Joint Surgery-American Volume 97 (8), pp. 635–642, 2015.
[3] Lehnen K, Giesinger K, Warschkow R, et al. Clinical outcome using a ligament referencing technique in CAS versus conventional technique. Knee Surg Sports Traumatol Arthrosc Volume 19 (6), pp. 887-892, 2011.
[4] Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR). Hip, Knee & Shoulder Arthroplasty: 2018 Annual Report. Adelaide: AOA, 2018.
[5] Pang H L, et al. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc Volume 19 (9), pp. 1496-1503, 2011.
[6] Chen JY, et al. Radiological outcomes of pinless navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. Volume 23 (12), pp. 3556-3562, 2015.