A Meta-Analysis Comparing Accelerometer-Based Portable Navigation Systems and Traditional Techniques in Total Knee Arthroplasty: Assessment of Radiological and Clinical Outcomes.

Abstract

In the past few years, accelerometer-based portable navigation (ABN) systems have been widely applied in total knee arthroplasty (TKA). However, there remains controversy regarding whether ABN systems are more accurate than traditional techniques. Since previous meta-analyses have reported inconsistent results, a meta-analysis incorporating studies of higher quality is required to compare the radiological and functional outcomes after TKA performed using ABN versus traditional techniques. Following Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, randomized controlled trials (RCTs) were retrieved from multiple databases. Outcomes included mechanical axis (MA), coronal femoral angle (CFA), coronal tibial angle (CTA), outliers, operation duration, blood loss, Knee Society Score (KSS), and Knee Function Score (KFS). A total of nine studies involving 956 knees were included in this meta-analysis. The postoperative MA accuracy in the ABN group was significantly better than that in the conventional group [mean difference (MD) = -0.78, 95% confidence interval (CI) (-0.94 to -0.62), P < 0.00001]. The proportion of MA outliers was 9.6 in the ABN group versus 23.7% in the conventional group, suggesting that ABN may be associated with a lower incidence of MA outliers. Compared with conventional techniques, ABN was associated with improved CFA accuracy [MD = -0.56, 95% CI (-0.69 to -0.43), P < 0.00001] and also showed improved CTA accuracy [MD = -0.31, 95% CI (-0.58 to 0.03), P = 0.03]. Meanwhile, ABN reduced the risk of CFA outliers [relative risk (RR) = 0.22, 95% CI (0.12 to 0.40), P < 0.00001] and the risk of CTA outliers [RR = 0.48, 95% CI (0.28 to 0.81), P = 0.006]. There were no significant differences found in blood loss, operation duration, KSS, or KFS. This study was registered in PROSPERO (CRD: 321231). The ABN-assisted TKA enhances lower extremity alignment accuracy without prolonging operation time, but shows no beneficial effects on functional outcomes at a mean follow-up of six months. Level II; Systematic review and meta-analysis of heterogeneous Level I randomized controlled trials.