Computer navigation does not improve 10-year functional outcomes following total knee arthroplasty: A randomised clinical trial

Abstract

Purpose: The use of computer-assisted surgery (CAS) in total knee arthroplasty (TKA) has been widely shown to be beneficial in improving prostheses alignment. The evidence of correlation to superior functional result, however is both sparse and conflicting. Methods: TKA participants were randomised into one of three trial arms to compare implantation techniques; CAS, intramedullary instrumentation guides for femur and tibia or intramedullary guides for femur and extramedullary tibial jigs. This was a single centre trial, with one senior surgeon performing all surgeries through a standardised medial parapatellar approach and cemented prostheses. Participants were blinded to surgical technique, and post-operatively followed up for 10 years. Outcome measures included a Numerical Knee Pain Rating, Oxford Knee Score and Short Form Health Survey and Likert satisfaction score. Results: 107 patients were successfully randomised for age, body mass index and knee function. Mean surgical times were 112 minutes for CAS, 82 minutes for EM/IM and 79 minutes for IM/IM. 68 patients completed 10-year follow-up. We failed to find significant differences in knee pain (p=0.11), knee function (p=0.24), satisfaction (p=0.43) or health status physical component score (p=0.06) or mental component score (p=0.29) at 10 years. Conclusion: 10-year results of this study indicate that compared to conventional techniques, CAS fails to provide superior long-term functional outcomes for patients undergoing TKA.