Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis
Tóm tắt
Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.
Tài liệu tham khảo
Alcelik IA, Blomfield MI, Diana G, Gibbon AJ, Carrington N, Burr S (2016) A comparison of short-term outcomes of minimally invasive computer-assisted vs minimally invasive conventional instrumentation for primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 31(2):410–418
Annual Report 2014 Australian Hip and Knee Arthroplasty Register (2014). https://aoanjrr.dmac.adelaide.edu.au/documents/10180/172286/AnnualReport2014. Accessed 20 Aug 2016
Annual Report 2015 Swedish Knee Arthroplasty Register (2015). http://www.myknee.se/pdf/SVK_2015_Eng_1.0.pdf. Accessed 20 Aug 2016
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S (2004) Grading quality of evidence and strength of recommendations. BMJ 328(7454):1490
Attfield SF, Wilton TJ, Pratt DJ, Sambatakakis A (1996) Soft-tissue balance and recovery of proprioception after total knee replacement. J Bone Joint Surg Br 78(4):540–545
Babazadeh S, Stoney JD, Lim K, Choong PF (2009) The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature. Orthop Rev (Pavia) 1(2):e26
Barbadoro P, Ensini A, Leardini A, d’Amato M, Feliciangeli A, Timoncini A, Amadei F, Belvedere C, Giannini S (2014) Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 22(12):3157–3162
Barink M, Verdonschot N, de Waal Malefijt M (2003) A different fixation of the femoral component in total knee arthroplasty may lead to preservation of femoral bone stock. Proc Inst Mech Eng H 217(5):325–332
Barrett WP, Mason JB, Moskal JT, Dalury DF, Oliashirazi A, Fisher DA (2011) Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. J Arthroplasty 26(8):1273–1284
Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement: a meta-analysis. J Bone Joint Surg Am 89(2):261–269
Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116
Bin Abd Razak HR, Yeo Jin S, Chong Chi H (2014) Computer navigation results in less severe flexion contracture following total knee arthroplasty. J Arthroplasty 29(12):2369–2372
Bonnin MP, Saffarini M, Shepherd D, Bossard N, Dantony E (2015) Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 24(8):2532–2540
Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2314–2324
Bonutti PM, Dethmers D, Ulrich SD, Seyler TM, Mont MA (2008) Computer navigation-assisted versus minimally invasive TKA: benefits and drawbacks. Clin Orthop Relat Res 466(11):2756–2762
Borenstein M, Hedges LV, Higgins J, Rothstein HR (2009) Introduction to meta-analysis. Wiley, Chichester
Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J (2011) Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop 35(3):331–339
Burnett RS, Nair R, Hall CA, Jacks DA, Pugh L, McAllister MM (2014) Results of the Oxford Phase 3 mobile bearing medial unicompartmental knee arthroplasty from an independent center: 467 knees at a mean 6-year follow-up: analysis of predictors of failure. J Arthroplasty 29(9 Suppl):193–200
Centre of excellence of joint replacements (2010) The Norwegian arthroplasty register
Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA, Gill HS, Murray DW (2009) Tibial component overhang following unicompartmental knee replacement–does it matter? Knee 16(5):310–313
Cheng T, Pan XY, Mao X, Zhang GY, Zhang XL (2012) Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 19(4):237–245
Cheng T, Zhang G, Zhang X (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Orthop Surg Res 171(2):590–600
Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20(7):1307–1322
Cip J, Widemschek M, Luegmair M, Sheinkop MB, Benesch T, Martin A (2014) Conventional versus computer-assisted technique for total knee arthroplasty: a minimum of 5-year follow-up of 200 patients in a prospective randomized comparative trial. J Arthroplasty 29(9):1795–1802
Citak M, Suero EM, Citak M, Dunbar NJ, Branch SH, Conditt MA, Banks SA, Pearle AD (2013) Unicompartmental knee arthroplasty: is robotic technology more accurate than conventional technique? Knee 20(4):268–271
Clark TC, Schmidt FH (2013) Robot-assisted navigation versus computer-assisted navigation in primary total knee arthroplasty: efficiency and accuracy. ISRN Orthop 2013:794827
Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B (2006) Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 88(2):188–197
Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA (2006) Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty 21(6 Suppl 2):108–115
Conteduca F, Iorio R, Mazza D, Ferretti A (2014) Patient-specific instruments in total knee arthroplasty. Int Orthop 38(2):259–265
Coon T, Roche M, Pearle AD, Dounchis J, Borus T, Buechel Jr F (2013) Two year survivorship of robotically guided unicompartmental knee arthroplasty. Paper presented at the ISTA 26th annual congress, Palm Beach, FL, USA
De Steiger RN, Liu YL, Graves SE (2015) Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 97(8):635–642
Decking R, Markmann Y, Mattes T, Puhl W, Scharf HP (2007) On the outcome of computer-assisted total knee replacement. Acta Chir Orthop Traumatol Cech 74(3):171–174
Dobzyniak M, Fehring TK, Odum S (2006) Early failure in total hip arthroplasty. Clin Orthop Relat Res 447:76–78
Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA (2012) Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplasty 27(5):803–808
Eagar P, Hull ML, Howell SM (2004) How the fixation method stiffness and initial tension affect anterior load-displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft. J Orthop Res 22(3):613–624
Ek ET, Dowsey MM, Tse LF, Riazi A, Love BR, Stoney JD, Choong PF (2008) Comparison of functional and radiological outcomes after computer-assisted versus conventional total knee arthroplasty: a matched-control retrospective study. J Orthop Surg (Hong Kong) 16(2):192–196
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318
Fricka KB, Sritulanondha S, McAsey CJ (2015) To cement or not? Two-year results of a prospective, randomized study comparing cemented vs. cementless total knee arthroplasty (TKA). J Arthroplasty 30(9 Suppl):55–58
Fu Y, Wang M, Liu Y, Fu Q (2012) Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(6):1075–1082
Gioe TJ, Killeen KK, Grimm K, Mehle K, Scheltema K (2004) Why are total knee replacements revised? Clin Orthop Relat Res 428:100–106
Gøthesen O, Espehaug B, Havelin L, Petursson G, Furnes O (2011) Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008. Acta Orthop 82(3):293–300
Hansen DC, Kusuma SK, Palmer RM, Harris KB (2014) Robotic guidance does not improve component position or short-term outcome in medial unicompartmental knee arthroplasty. J Arthroplasty 29(9):1784–1789
Harvie P, Sloan K, Beaver RJ (2012) Computer navigation vs conventional total knee arthroplasty. Five-year functional results of a prospective randomized trial. J Arthroplasty 27(5):667–672
Hasegawa M, Yoshida K, Wakabayashi H, Sudo A (2011) Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome. Knee Surg Sports Traumatol Arthrosc 19(6):904–910
Hernández-Vaquero D, Suarez-Vazquez A, Iglesias-Fernandez S (2011) Can computer assistance improve the clinical and functional scores in total knee arthroplasty? Clin Orthop Relat Res 469(12):3436–3442
Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty 27(6):1177–1182
Hoppe S, Mainzer JD, Frauchiger L, Ballmer PM, Hess R, Zumstein MA (2012) More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up. Acta Orthop 83(6):629–633
Huang NF, Dowsey MM, Ee E, Stoney JD, Babazadeh S, Choong PF (2012) Coronal alignment correlates with outcome after total knee arthroplasty: five-year follow-up of a randomized controlled trial. J Arthroplasty 27(9):1737–1741
Huang TW, Lee CY, Lin SJ, Peng KT, Huang KC, Lee MS, Hsu RW, Shen WJ (2014) Comparison of computer-navigated and conventional total knee arthroplasty in patients with Ranawat type-II valgus deformity: medium-term clinical and radiological results. BMC Musculoskelet Disord 15:390
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714
Ji HM, Han J, Jin DS, Seo H, Won YY (2016) Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24(8):2436–2441
Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE (2009) Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop 33(6):1567–1570
Kendrick BJ, Kaptein BL, Valstar ER, Gill HS, Jackson WF, Dodd CA, Price AJ, Murray DW (2015) Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone Joint J 97-B(2):185–191
Khamaisy S, Zuiderbaan HA, van der List JP, Nam D, Pearle AD (2016) Medial unicompartmental knee arthroplasty improves congruence and restores joint space width of the lateral compartment. Knee 23(3):501–505
Kim SM, Park YS, Ha CW, Lim SJ, Moon YW (2012) Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics 35(9):e1334–e1339
Kim TK, Chang CB, Kang YG, Chung BJ, Cho HJ, Seong SC (2010) Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty. Knee 17(1):23–28
Kim YH, Park JW, Kim JS (2012) Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am 94(22):2017–2024
Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38(2):379–385
Konyves A, Willis-Owen CA, Spriggins AJ (2010) The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty. J Orthop Surg Res 5:94
Koulalis D, O’Loughlin PF, Plaskos C, Kendoff D, Cross MB, Pearle AD (2011) Sequential versus automated cutting guides in computer-assisted total knee arthroplasty. Knee 18(6):436–442
Labek G, Sekyra K, Pawelka W, Janda W, Stockl B (2011) Outcome and reproducibility of data concerning the Oxford unicompartmental knee arthroplasty: a structured literature review including arthroplasty registry data. Acta Orthop 82(2):131–135
Lee WT, Chin PL, Lo NN, Yeo SJ (2015) Short-term outcome after computer-assisted versus conventional total knee arthroplasty: a randomised controlled trial. J Orthop Surg (Hong Kong) 23(1):71–75
Lehnen K, Giesinger K, Warschkow R, Porter M, Koch E, Kuster MS (2011) Clinical outcome using a ligament referencing technique in CAS versus conventional technique. Knee Surg Sports Traumatol Arthrosc 19(6):887–892
Lin SY, Chen CH, Fu YC, Huang PJ, Lu CC, Su JY, Chang JK, Huang HT (2013) Comparison of the clinical and radiological outcomes of three minimally invasive techniques for total knee replacement at two years. Bone Joint J 95(7):906–910
Liow MH, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 29(12):2373–2377
Liow MHL, Chin PL, Tay KJD, Chia SL, Lo NN, Yeo SJ (2014) Early experiences with robot-assisted total knee arthroplasty using the digiMatch™ ROBODOC® surgical system. Singapore Med J 55(10):529–534
Lonner JH (2009) Robotic arm-assisted unicompartmental arthroplasty. Semin Arthroplasty 20(1):15–22
Lonner JH, John TK, Conditt MA (2010) Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 468(1):141–146
Lonner JH, Smith JR, Picard F, Hamlin B, Rowe PJ, Riches PE (2015) High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study. Clin Orthop Relat Res 473(1):206–212
Luring C, Kauper M, Bathis H, Perlick L, Beckmann J, Grifka J, Tingart M, Rath B (2012) A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters. Int Orthop 36(3):553–558
Lutzner J, Dexel J, Kirschner S (2013) No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 21(10):2241–2247
MacCallum KP, Danoff JR, Geller JA (2016) Tibial baseplate positioning in robotic-assisted and conventional unicompartmental knee arthroplasty. Eur J Orthop Surg Traumatol 26(1):93–98
Manzotti A, Cerveri P, Pullen C, Confalonieri N (2014) Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique. Int Orthop 38(2):457–463
Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89(2):236–243
Meijer MF, Reininga IH, Boerboom AL, Bulstra SK, Stevens M (2014) Does imageless computer-assisted TKA lead to improved rotational alignment or fewer outliers? A systematic review. Clin Orthop Relat Res 472(10):3124–3133
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097
Molfetta L, Caldo D (2008) Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee 15(2):75–79
Mont MA, Pivec R, Issa K, Kapadia BH, Maheshwari A, Harwin SF (2014) Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis. J Knee Surg 27(5):369–376
Moon YW, Ha CW, Do KH, Kim CY, Han JH, Na SE, Lee CH, Kim JG, Park YS (2012) Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 17(2):86–95
Moskal JT, Capps SG, Mann JW, Scanelli JA (2014) Navigated versus conventional total knee arthroplasty. J Knee Surg 27(3):235–248
Mueller JK, Wentorf FA, Moore RE (2014) Femoral and tibial insert downsizing increases the laxity envelope in TKA. Knee Surg Sports Traumatol Arthrosc 22(12):3003–3011
Nair R, Tripathy G, Deysine GR (2014) Computer navigation systems in unicompartmental knee arthroplasty: a systematic review. Am J Orthop (Belle Mead NJ) 43(6):256–261
Nam D, McArthur BA, Cross MB, Pearle AD, Mayman DJ, Haas SB (2012) Patient-specific instrumentation in total knee arthroplasty: a review. J Knee Surg 25(3):213–219
National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2015) 12th Annual report
Nedopil AJ, Howell SM, Hull ML (2016) Does malrotation of the tibial and femoral components compromise function in kinematically aligned total knee arthroplasty? Orthop Clin North Am 47(1):41–50
The New Zealand Joint Registry (2014) Fourteen year report. January 1999 to December 2013
Niinimaki TT, Murray DW, Partanen J, Pajala A, Leppilahti JI (2011) Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates. Knee 18(6):432–435
Pabinger C, Berghold A, Boehler N, Labek G (2013) Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers. Osteoarthr Cartil 21(2):263–268
Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46
Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93(2):198–204
Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 19(9):1496–1503
Park SE, Lee CT (2007) Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty 22(7):1054–1059
Pearle AD, O’Loughlin PF, Kendoff DO (2010) Robot-assisted unicompartmental knee arthroplasty. J Arthroplasty 25(2):230–237
Plate JF, Mofidi A, Mannava S, Smith BP, Lang JE, Poehling GG, Conditt MA, Jinnah RH (2013) Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop 2013:837167
Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173
Rebal BA, Babatunde OM, Lee JH, Geller JA, Patrick DA Jr, Macaulay W (2014) Imageless computer navigation in total knee arthroplasty provides superior short term functional outcomes: a meta-analysis. J Arthroplasty 29(5):938–944
Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156
Roberts TD, Clatworthy MG, Frampton CM, Young SW (2015) Does computer assisted navigation improve functional outcomes and implant survivability after total knee arthroplasty? J Arthroplasty 30(9):59–63
Roche M, Elson L, Anderson C (2014) Dynamic soft tissue balancing in total knee arthroplasty. Orthop Clin North Am 45(2):157–165
Rosskopf J, Singh PK, Wolf P, Strauch M, Graichen H (2014) Influence of intentional femoral component flexion in navigated TKA on gap balance and sagittal anatomy. Knee Surg Sports Traumatol Arthrosc 22(3):687–693
Ryd L, Lindstrand A, Stenström A, Selvik G (1990) Porous coated anatomic tricompartmental tibial components: the relationship between prosthetic position and micromotion. Clin Orthop Relat Res 251:189–197
Schmitt J, Hauk C, Kienapfel H, Pfeiffer M, Efe T, Fuchs-Winkelmann S, Heyse TJ (2011) Navigation of total knee arthroplasty: rotation of components and clinical results in a prospectively randomized study. BMC Musculoskelet Disord 12:16
Schnurr C, Güdden I, Eysel P, König DP (2012) Influence of computer navigation on TKA revision rates. Int Orthop 36(11):2255–2260
Seon JK, Song EK, Park SJ, Yoon TR, Lee KB, Jung ST (2009) Comparison of minimally invasive unicompartmental knee arthroplasty with or without a navigation system. J Arthroplasty 24(3):351–357
Shi J, Wei Y, Wang S, Chen F, Wu J, Huang G, Chen J, Wei L, Xia J (2014) Computer navigation and total knee arthroplasty. Orthopedics 37(1):e39–e43
Siebert W, Mai S, Kober R, Heeckt PF (2002) Technique and first clinical results of robot-assisted total knee replacement. Knee 9(3):173–180
Sierra RJ, Kassel CA, Wetters NG, Berend KR, Della Valle CJ, Lombardi AV (2013) Revision of unicompartmental arthroplasty to total knee arthroplasty: not always a slam dunk! J Arthroplasty 28(8 Suppl):128–132
Singh VK, Varkey R, Trehan R, Kamat Y, Raghavan R, Adhikari A (2012) Functional outcome after computer-assisted total knee arthroplasty using measured resection versus gap balancing techniques: a randomised controlled study. J Orthop Surg (Hong Kong) 20(3):344–347
Sinha RK (2009) Outcomes of robotic arm-assisted unicompartmental knee arthroplasty. Am J Orthop (Belle Mead NJ) 38(2 Suppl):20–22
Smith JR, Riches PE, Rowe PJ (2014) Accuracy of a freehand sculpting tool for unicondylar knee replacement. Int J Med Robot 10(2):162–169
Song EK, Mohite N, Lee SH, Na BR, Seon JK (2015) Comparison of outcome and survival after unicompartmental knee arthroplasty between navigation and conventional techniques with an average 9-year follow-up. J Arthroplasty 31(2):395–400
Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW (2011) Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 19(7):1069–1076
Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL (2013) Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 471(1):118–126
Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89(4):477–480
Sriphirom P, Raungthong N, Chutchawan P, Thiranon C, Sukandhavesa N (2012) Influence of a secondary downsizing of the femoral component on the extension gap: a cadaveric study. Orthopedics 35(10 Suppl):56–59
Stiehl JB, Heck DA (2015) How precise is computer-navigated gap assessment in TKA? Clin Orthop Relat Res 473(1):115–118
Stulberg SD, Yaffe MA, Koo SS (2006) Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88(Suppl 4):47–54
Thiengwittayaporn S, Kanjanapiboonwong A, Junsee D (2013) Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty. J Orthop Surg Res 8:37
Thienpont E, Fennema P, Price A (2013) Can technology improve alignment during knee arthroplasty. Knee 20:S21–S28
Tolk JJ, Koot HW, Janssen RP (2012) Computer navigated versus conventional total knee arthroplasty. J Knee Surg 25(4):347–352
van der List JP, Chawla H, Pearle AD (2016) Robotic-assisted knee arthroplasty: an overview. Am J Orthop (Belle Mead NJ) 45(4):202–211
van der List JP, Chawla H, Villa JC, Zuiderbaan HA, Pearle AD (2015) Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3877-0
van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) Patient selection criteria for unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty. doi:10.1016/j.arth.2016.04.001
van der List JP, McDonald LS, Pearle AD (2015) Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 22(6):454–460
van der List JP, Zuiderbaan HA, Pearle AD (2016) Why do medial unicompartmental knee arthroplasties fail today? J Arthroplasty 31(5):1016–1021
van Strien T, van der Linden-van der Zwaag E, Kaptein B, van Erkel A, Valstar E, Nelissen R (2009) Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component. Int Orthop 33 (5):1255–1261
Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Schiavone Panni A (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22(2):117–121
Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43
Weber P, Crispin A, Schmidutz F, Utzschneider S, Pietschmann MF, Jansson V, Muller PE (2013) Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(11):2453–2461
Weber P, Utzschneider S, Sadoghi P, Pietschmann MF, Ficklscherer A, Jansson V, Müller PE (2012) Navigation in minimally invasive unicompartmental knee arthroplasty has no advantage in comparison to a conventional minimally invasive implantation. Arch Orthop Trauma Surg 132(2):281–288
Whiteside LA (2005) Making your next unicompartmental knee arthroplasty last. J Arthroplasty 20:2–3
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85(1):1–3
Yaffe M, Chan P, Goyal N, Luo M, Cayo M, Stulberg SD (2013) Computer-assisted versus manual TKA: no difference in clinical or functional outcomes at 5-year follow-up. Orthopedics 36(5):e627–e632
Yang JH, Yoon JR, Pandher DS, Oh KJ (2010) Clinical and radiologic outcomes of contemporary 3 techniques of TKA. Orthopedics 33(10 Suppl):76–81
Yildirim G, Fernandez-Madrid I, Schwarzkopf R, Walker PS, Karia R (2014) Comparison of robot surgery modular and total knee arthroplasty kinematics. J Knee Surg 27(2):157–163
Yoshida K, Tada M, Yoshida H, Takei S, Fukuoka S, Nakamura H (2013) Oxford phase 3 unicompartmental knee arthroplasty in Japan—clinical results in greater than one thousand cases over ten years. J Arthroplasty 28(9 Suppl):168–171
Young SW, Clarke HD, Graves SE, Liu YL, de Steiger RN (2015) Higher rate of revision in PFC sigma primary total knee arthroplasty with mismatch of femoro-tibial component sizes. J Arthroplasty 30(5):813–817
Zamora LA, Humphreys KJ, Watt AM, Forel D, Cameron AL (2013) Systematic review of computer-navigated total knee arthroplasty. ANZ J Surg 83(1–2):22–30
Zhang Z, Gu B, Zhu W, Zhu L, Li Q, Du Y (2014) Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study. Eur J Orthop Surg Traumatol 24(8):1475–1479
Zhang Z, Zhu W, Zhu L, Du Y (2014) Superior alignment but no difference in clinical outcome after minimally invasive computer-assisted unicompartmental knee arthroplasty (MICA-UKA). Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3456-9
Zhu M, Ang CL, Yeo SJ, Lo NN, Chia SL, Chong HC (2015) Minimally invasive computer-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a prospective 9-year follow-up. J Arthroplasty 31(5):1000–1004
Zihlmann MS, Stacoff A, Romero J, Quervain IK, Stussi E (2005) Biomechanical background and clinical observations of rotational malalignment in TKA: literature review and consequences. Clin Biomech (Bristol, Avon) 20(7):661–668
Zuiderbaan HA, Khamaisy S, Thein R, Nawabi DH, Pearle AD (2015) Congruence and joint space width alterations of the medial compartment following lateral unicompartmental knee arthroplasty. Bone Joint J 97(1):50–55