Evidence map›Paper›PMID 21732057›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2012

Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?

Tao Cheng, Song Zhao, Xiaochun Peng, Xianlong Zhang

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 112 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
112citing papers in PubMed, 7 pooled it
18.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

112 citing papers in PubMed, 7 syntheses or guidelines pooled it, 239 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2015
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2013
    Pooled it
  8. Trial
  9. Trial
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  11. Conventional versus computer-navigated TKA: a prospective randomized study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2017
    Trial
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  13. Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2014
    Trial
  14. Trial
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  17. Intraoperative fluoroscopy improves surgical precision in conventional TKA.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2014
    Trial
  18. Evaluation of the accuracy of a patient-specific instrumentation by navigation.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2013
    Trial
  19. Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2013
    Trial
  20. Trial

52 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Tao ChengDepartment of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yisan Road, Shanghai, 200233, People's Republic of China.
Song Zhao
Xiaochun Peng
Xianlong Zhang
Shanghai Sixth People's Hospital · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeComputer-assisted surgery has been proposed as a technique to improve implant alignment during total knee arthroplasty (TKA). However, there is still a debate over the accuracy of placing the femoral and tibial components using computer-assisted systems in TKA. The aim of this study is to establish whether computer-assisted surgery leads to superior mechanical leg axis and implant positioning than conventional technique in patients with primary TKA.

methodsMajor electronic databases were systematically searched to identify relevant studies without language restriction. A meta-analysis of 41 randomized controlled trials (RCTs) or quasi-RCTs was performed in a random effects model. A subgroup analysis was conducted by type of navigation system to explore the clinical heterogeneity between these trials. The following radiographic parameters were used to compare computer-assisted surgery with conventional technique: (1) mechanical leg axis, (2) femoral component coronal alignment, (3) tibial component coronal alignment, (4) femoral component sagittal alignment, and (5) tibial component sagittal alignment.

resultsFor the mechanical leg axis and coronal positioning of femoral and tibial components, there are statistically significant reductions in the number of patients with malalignment in the CAS group if the outlier cutoff value is ±3 or 2° in the coronal and sagittal planes, respectively. Subgroup analysis demonstrates that CT-free navigation systems provide better alignment than conventional techniques in the coronal and sagittal alignment of femoral components within ±3 and 2°. If the outlier cutoff value for the tibial sagittal alignment is ±2°, the outlier percentages are higher in the CT-free navigation group than in the conventional group. However, there was no significant difference in the tibial sagittal alignment at ±3°.

conclusionComputer-assisted surgery does improve mechanical leg axis and component orientation in TKAs. However, high-quality RCTs are necessary to determine whether surgeons could use computer-assisted techniques to achieve a targeted tibial slope in TKA. LEVEL OF EVIDENCE: Therapeutic study (Systematic review of Level I/II studies), Level II.

Indexed as

Arthroplasty, Replacement, KneeKnee ProsthesisProsthesis FittingSurgery, Computer-AssistedFemurHumansRadiography, InterventionalRandomized Controlled Trials as TopicTibiaTomography, X-Ray Computed

Identifiers

PMID21732057
OpenAlexW2022087213

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.