The rebirth of computer-assisted surgery. Precise prosthetic implantation should be considered when targeting individual
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EDITORIAL
The rebirth of computer‑assisted surgery. Precise prosthetic implantation should be considered when targeting individualized alignment goals in total knee arthroplasty Pascal‑André Vendittoli1,2 · Charles Rivière2,3,4 · Samuel MacDessi2,5,6 Received: 16 August 2020 / Accepted: 18 September 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
To match increasing patient expectations and hip replacement’s clinical results, significant improvements in total knee arthroplasty (TKA) clinical outcomes are required. Rates of dissatisfaction and residual symptoms (e.g. pain, instability, stiffness) following mechanically aligned (MA) TKA of 15% and 50% respectively are an ongoing concern [1]. In addition, patients’ perception of their prosthetic knee is rarely “natural” and Forgotten Joint Scores are disappointing [2]. Last, MA TKA fails to restore individual native knee joint kinematics, viewed as an important factor for knee function, joint perception, and patient satisfaction after surgery [3, 4]. Use of computer-assisted surgery (CAS) to increase alignment precision in TKA has not resulted in corresponding improvements in patient outcomes with a mechanical alignment target [5]. Kim et al. randomized 296 patients undergoing bilateral, simultaneous TKA to MA-CAS for one knee and MA with use of conventional instruments (CON) for the other. At a minimum of 14 years, no benefit with CAS in terms of pain, function, or implant survivorship was observed [6]. In a larger study, Roberts et al. * Pascal‑André Vendittoli [email protected] 1
Surgery Department, Hôpital Maisonneuve‑Rosemont, Montreal University, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4, Canada
2
Personalized Arthroplasty Society, Montréal, Canada
3
MSK Laboratory, Imperial College London, Sir Michael Uren Hub, White City Campus, 86 Wood Ln, London W12 0BZ, UK
4
Centre de l’Arthrose, Clinique du Sport, 4 Rue Georges Negrevergne, 33700 Mérignac, France
5
Sydney Knee Specialists Suite 201, 131 Princes Hway, Kogarah, Sydney, NSW 2217, Australia
6
University of New South Wales St George and Sutherland Clinical School Kogarah, Sydney, NSW 2217, Australia
analyzed outcomes in 19,221 TKAs from the New Zealand Joint Registry by comparing 2 cohorts of patients: those performed by routine CAS surgeons and those performed by routine CON surgeons. No difference in survivorship or patient outcomes to support the use of CAS in TKA was found [7]. Conversely, the Australian Orthopedic Association National Joint Replacement Registry reported reduced overall revisions and revisions for loosening and lysis rates in patients under the age of 65 with use of CAS [8]. Last, a meta-analysis of 9 RCTs including over 2000 TKAs with a minimum 8 years follow-up revealed more precise implant orientation but no significant differences in patient outcomes or revision rates between the two techniques [9]. When assessing the performance of precision tools such as CAS, patient-specific cutting guides, and robotic-a
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