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Comparative Effectiveness Review of Image-Based Computer-Aided Navigation for Total Knee Arthroplasty

March 29, 2019

Health Problem: Osteoarthritis of the knee is the primary indication for total knee arthroplasty (TKA) in the United States. Many TKA recipients are unsatisfied with the amount of pain relief and functional improvement they have long term. Malalignment of the implant has particularly been associated with poor clinical outcomes, early implant loosening, premature implant wear, and arthroplasty failure. Unsuccessful TKA may lead to revision surgery. Due to an increasingly aged population, the number of TKAs is expected to increase to an estimated 3.48 million surgeries by 2030.

Technology Description: Computer-aided navigation (CAN) is intended to help the surgeon improve the accuracy of bone resection as well as prosthesis positioning and alignment by informing the placement of tools such as templates or cutting blocks. In image-based CAN, preoperative computed tomography, magnetic resonance imaging, or fluoroscopy is used to provide stereotactic registration of the joint surface and alignment. These navigation systems have graphical interfaces that display patient anatomy and cut planning and location of tracked instruments in real time.

Controversy: Evidence suggests that image-based CAN may improve alignment, but the impact on clinical outcomes and cost-effectiveness of CAN are unclear. An updated evaluation comparing image-based CAN and imageless CAN is warranted to clarify their comparative efficacy.

Key Questions:

For patients undergoing TKA:

  • How do clinical outcomes of image-based CAN compare with conventional surgeon-directed navigation for TKA in patients with osteoarthritis of the knee?
  • How do clinical outcomes of image-based CAN compare with imageless CAN for TKA?
  • What complications are associated with image-based CAN, and how do they compare with other methods of navigation?
  • Have definitive patient selection criteria for image-based CAN for TKA been established?