Current Role of Computer Navigation in Total Knee Arthroplasty
Current Role of Computer Navigation in Total Knee Arthroplasty
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DOI：
10.1016/j.arth.2018.01.027
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发表时间：
2018-07-01
影响因子：
3.5
通讯作者：
Jerabek, Seth A.
中科院分区：
文献类型：
--
作者：
Jones, Christopher W.;Jerabek, Seth A.
背景资料：开发计算机辅助手术（CAS）导航的目的是提高全膝关节置换术（TKA）部件定位的准确性和精密度，从而提高整体肢体对线。膝关节置换术的历史目标是通过使股骨和胫骨部件垂直于股骨和胫骨的机械轴对齐来恢复下肢的机械对线。尽管TKA部件开发超过40年，CAS研究近20年，但基本问题仍然存在;对线目标和/或实现该目标的方法是否会影响TKA的患者报告结局指标和/或总体生存率？对术中对线目标的可靠性和可重复性的追求一直是引入、开发和完善CAS导航的主要动力。现在存在许多专有系统，计算机处理能力的快速技术进步正在刺激机器人手术系统的进一步发展。三个类别的CAS可以定义：基于图像的大型控制台导航; imageless大型控制台导航，最近，基于加速计的手持导航systems.Conclusion：目前的文献综述表明，有足够的精心设计的研究得出结论，大型控制台CAS和手持导航系统提高了TKA组件对齐的准确性和精度。然而，除了澳大利亚骨科协会国家关节置换登记中心提供的亚组分析外，证据基础中缺少任何关于改善患者报告结局指标和/或降低长期累积翻修率方面的临床优效性的结论性证据。很少有作者会认为对线的准确性是一个可以忽略的目标;因此，在缺乏临床证据的情况下，许多反对使用大型控制台CAS导航的论点都集中在系统的高昂成本上。因此，使用低成本的手持式CAS导航系统可能会弥补这一重要差距，随着时间的推移，可能会出现更多的临床证据。(C)2018爱思唯尔公司All rights reserved.
Background: Computer-assisted surgical (CAS) navigation has been developed with the aim of improving the accuracy and precision of total knee arthroplasty (TKA) component positioning and therefore overall limb alignment. The historical goal of knee arthroplasty has been to restore the mechanical alignment of the lower limb by aligning the femoral and tibial components perpendicular to the mechanical axis of the femur and tibia. Despite over 4 decades of TKA component development and nearly 2 decades of interest in CAS, the fundamental question remains; does the alignment goal and/or the method of achieving that goal affect the outcome of the TKA in terms of patient-reported outcome measures and/or overall survivorship? The quest for reliable and reproducible achievement of the intraoperative alignment goal has been the primary motivator for the introduction, development, and refinement of CAS navigation. Numerous proprietary systems now exist, and rapid technological advancements in computer processing power are stimulating further development of robotic surgical systems. Three categories of CAS can be defined: image-based large-console navigation; imageless large-console navigation, and more recently, accelerometer-based handheld navigation systems have been developed.Conclusion: A review of the current literature demonstrates that there are enough well-designed studies to conclude that both large-console CAS and handheld navigation systems improve the accuracy and precision of component alignment in TKA. However, missing from the evidence base, other than the subgroup analysis provided by the Australian Orthopaedic Association National Joint Replacement Registry, are any conclusive demonstrations of a clinical superiority in terms of improved patient-reported outcome measures and/or decreased cumulative revision rates in the long term. Few authors would argue that accuracy of alignment is a goal to ignore; therefore, in the absence of clinical evidence, many of the arguments against the use of large-console CAS navigation center on the prohibitive cost of the systems. The utilization of low-cost, handheld CAS navigation systems may therefore bridge this important gap, and over time, further clinical evidence may emerge. (C) 2018 Elsevier Inc. All rights reserved.