Navigated versus non-navigated total knee arthroplasty: A large single-implant cohort analysis of clinical outcomes and survivorship.

Abstract

The aim of this study was to compare implant survival, clinical outcomes and radiographic alignment between navigated and non-navigated total knee arthroplasty (TKA) performed with a single implant system. A retrospective multicenter analysis of prospectively collected data from 6078 TKAs performed for primary osteoarthritis using a single implant system was performed. Procedures were divided into two groups: navigated (<i>n</i> = 3602) and non-navigated (<i>n</i> = 2476). The primary outcome was implant survival. Secondary outcomes included re-intervention rates, patient-reported outcomes measures (PROMs, International Knee Society scores), and range of motion. Five-year implant survival was similar between the non-navigated (98.9%; 95% confidence interval [CI], 98.2%-99.3%) and navigated (98.3%; 95% CI, 97.6%-98.8%) groups (<i>p</i> = 0.505). After adjustment for potential confounders, navigated procedures showed a slightly higher risk of surgical reintervention excluding infection (hazard ratio 1.42, 95% CI: 1.02-1.96, <i>p</i> = 0.036). PROM analyses were restricted to patients with both baseline and 5-year questionnaires (<i>n</i> = 470). The improvement of patient-reported functional outcomes at 5 years was not significantly different between groups (<i>p</i> = 0.893 after adjustment for potential confounders). Navigation was equivalent to conventional instrumentation TKA with respect to implant survival. After adjusting for confounders and excluding septic revisions, navigated procedures showed a slightly higher reoperation risk. No significant advantage in functional outcomes was observed at mid-term follow-up. These findings do not support a clear clinical benefit for routine use of navigation in this setting. Level III, retrospective comparative study.