Meta-analysis on alignment outcomes of total knee arthroplasty with portable navigation

Objective To conduct a meta-analysis of published studies comparing accelerometer-based navigation(ABN) and conventional instrumentation(CON) in total knee arthroplasty (TKA). Methods The Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Internet(CNKI), VIP and WanFang data bases were searched to identify randomized controlled trials (RCTs) and non-randomized controlled trials(nRCTs) articles comparing the ABN with CON in primary TKA up to May 2018; severe knee deformity and hip abnormity on the operation side were excluded. Study selection and assessment, data collection and analysis were undertaken by two authors independently. The meta-analysis was performed using Review Manager 5.3.0. Results Eleven studies were included, involving four RCTs and seven nRCTs. A total of 1 334 knees were compared between the navigated group (n=641) and the conventional group (n=693). Meta-analysis suggested that the outliers from mechanical axis in navigated group was less than that of conventional group[RR=0.57, 95%CI: (0.43, 0.76), P<0.05]. There was no significant difference between the two groups in coronal femoral component outliers[RR=0.45, 95%CI (0.20, 1.06), P=0.07], coronal tibial component outliers[RR=0.67, 95%CI (0.41, 1.11), P=0.12], sagittal femoral component outliers [RR=1.03, 95%CI (0.72, 1.46), P=0.89], sagittal tibial component outliers[RR=1.13, 95%CI (0.62, 2.07), P=0.69]. Conclusion Total knee arthroplasty with hand-held, portable navigation is more accurate than conventional surgery in achieving a neutral mechanical axis, but there is no difference in coronal and sagittal implant positioning; more high-quality, large-sample, multicenter RCTs are required for further investigation. Key words: Osteoarthritis, knee; Arthroplasty, replacement, knee; Surgery, computer-assisted; Meta analysis