Navigation and robotics in knee arthroplasty

Abstract

Background: The longevity of a knee prosthesis depends on the correct alignment of the prosthetic components and the mechanical leg axis as well as an optimal soft tissue balancing. Computer-assisted surgery has been developed to achieve this goal more precisely and safely. The aim of this article is to assess the navigation and robotics and to discuss the current results. Methods: Comprehensive literature search in the PubMed database and the Google Scholar search service. Results: Computer-assisted surgery leads to a more precise alignment of both the mechanical leg axis and the positioning of prosthetic components. Nevertheless, the clinical results for knee function and the results of patient reported outcome measures (PROM) are controversial. They show no significant differences to conventional techniques and the same applies for the survival rates. High acquisition and maintenance costs limit the dissemination of these systems. Conclusion: At present, imaging-assisted navigation provides the surgeon with valuable support for more precise and safe work with respect to specific surgical steps. Nevertheless, long-term studies on knee function, PROMs and survival rate of the prosthesis are urgently needed, especially in robotics, even if the short-term results show trends similar to those for navigation. Robotic systems certainly need further development to meet the requirements of users and patients (costs, size, programming).