Division of Orthopaedic Surgery, University of Victoria/University of British Columbia, Vancouver Island Health, Royal Jubilee Hospital, Suite 305-1120, Yates St., Victoria, BC, Canada V8V-3M9.
Clin Orthop Relat Res. 2013 Jan;471(1):264-76. doi: 10.1007/s11999-012-2528-8.
Navigated total knee arthroplasty (TKA) may improve coronal alignment outliers; however, it is unclear whether navigated TKA improves the long-term clinical results of TKA.
QUESTIONS/PURPOSES: Does the literature contain evidence of better long-term function and lower revision rates with navigated TKA compared with conventional TKA?
A systematic literature review was conducted of navigated TKA reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction, component rotation, anteroposterior and mediolateral stability, complications, and longer-term reports.
Coronal plane alignment is improved with navigated TKA with fewer radiographic outliers. We found limited evidence of improvements in any other variable, and function was not improved. The duration of surgery is increased and there are unique complications related to navigated TKA. The long-term benefits of additional increase in accuracy of alignment are not supported by any current evidence.
The findings in reports of navigated TKA should be interpreted with caution. There are few short- and medium- and no long-term studies demonstrating improved clinical outcomes using navigated TKA. Despite substantial research, contradictory findings coupled with reservations about the cost and efficacy of the technology have contributed to the failure of computer navigation to become the accepted standard in TKA. Longer-term studies demonstrating improved function, lower revision rates, and acceptable costs are required before navigated TKA may be widely adopted. In the future, with improvements in study design, methodology, imaging, navigation technology, newer functional outcome tools, and longer-term followup studies, we suspect that navigated TKA may demonstrate yet unrecognized benefits.
导航全膝关节置换术（TKA）可能改善冠状面对线不良；然而，尚不清楚导航 TKA 是否能改善 TKA 的长期临床结果。
问题/目的：与传统 TKA 相比，导航 TKA 是否具有更好的长期功能和更低的翻修率的证据？
对导航 TKA 的文献进行了系统综述，综述了与冠状面对线、临床膝关节和功能评分、成本、患者满意度、组件旋转、前后和内外稳定性、并发症以及更长期报告相关的文章。
导航 TKA 可改善冠状面对线，减少影像学对线不良。我们发现，除了对线准确性提高之外，其他任何变量都没有改善的证据，且功能没有得到改善。手术时间延长，且存在与导航 TKA 相关的独特并发症。目前没有任何证据支持增加对线准确性的额外长期获益。
应谨慎解释导航 TKA 报告中的发现。很少有短期、中期和长期研究表明使用导航 TKA 能改善临床结果。尽管进行了大量研究，但与该技术的成本和有效性相关的相互矛盾的发现以及保留意见导致计算机导航未能成为 TKA 的公认标准。在导航 TKA 可能被广泛采用之前，需要进行更长时间的研究，以证明其具有改善的功能、更低的翻修率和可接受的成本。在未来，随着研究设计、方法学、影像学、导航技术、新的功能评估工具和更长期的随访研究的改进，我们怀疑导航 TKA 可能显示出尚未被认识到的益处。
