{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:56:02Z","timestamp":1786982162478,"version":"build-2736575974"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Proponents of computer-assisted TKA suggest that better alignment of the TKAs will lead to improved long-term patient functional outcome and survivorship of the implants. However, there is little evidence about whether the improved position and alignment of the knee components obtained using computer navigation improve patient function and the longevity of the TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Questions\/purposes<\/jats:title>\n                    <jats:p>The purpose of this study was to determine whether (1) clinical results; (2) radiographic and CT scan results; and (3) the survival rate of TKA components would be better in patients having computer-assisted TKA than results of patients having TKA without computer-assisted TKA. In addition, we determined whether (4) complication rates would be less in the patients with computer-assisted TKA than those in patients with conventional TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a randomized trial between October 2000 and October 2002 in patients undergoing same-day bilateral TKA; in this trial, one knee was operated on using navigation, and the other knee was operated on without navigation. All 296 patients who underwent same-day bilateral TKA during that period were enrolled. Of those, 282 patients (95%) were accounted for at a mean of 15 years (range, 14-16 years). A total of 79% (223 of 282) were women and the mean age of the patients at the time of index arthroplasty was 59 \u00b1 7 years (range, 48-64 years). Knee Society knee score, WOMAC score, and UCLA activity score were obtained preoperatively and at latest followup. Radiographic measurements were performed including femorotibial angle, position of femoral and tibial components, level of joint line, and posterior condylar offset. Aseptic loosening was defined as a complete radiolucent line &gt; 1 mm in width around any component or migration of any component. Assessors and patients were blind to treatment assignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Knee Society knee (92 \u00b1 8 versus 93 \u00b1 7 points; 95% confidence interval [CI], 92-98; p = 0.461) and function scores (80 \u00b1 11 versus 80 \u00b1 11 points; 95% CI, 73-87; p = 1.000), WOMAC score (14 \u00b1 7 versus 15 \u00b1 8 points; 95% CI, 14-18; p = 0.991), range of knee motion (128\u00b0 \u00b1 9\u00b0 versus 127\u00b0 \u00b1 10\u00b0; 95% CI, 100-140; p = 0.780), and UCLA patient activity score (6 versus 6 points; 95% CI, 4-8; p = 1.000) were not different between the two groups at 15 years followup. There were no differences in any radiographic parameters of alignment (on radiography or CT scan) between the two groups. The frequency of aseptic loosening was not different between the two groups (p = 0.918). Kaplan-Meier survivorship of the TKA components was 99% in both groups (95% CI, 93-100) at 15 years as the endpoint of revision or aseptic loosening (p = 0.982). Anterior femoral notching was observed in 11 knees (4%) in the computer-assisted TKA group and none in the conventional TKA group (p = 0.046).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this randomized trial, with data presented at a minimum of 14 years of followup, we found no benefit to computer navigation in TKA in terms of pain, function, or survivorship. Unless another study at long-term followup identifies an advantage to survivorship, pain, and function, we do not recommend the widespread use of computer navigation in TKA because of its risks (in this series, we observed femoral notching; others have observed pin site fractures) and attendant costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level I, therapeutic study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000000","type":"journal-article","created":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T08:48:02Z","timestamp":1519202882000},"page":"6-15","source":"Crossref","is-referenced-by-count":76,"title":["2017 Chitranjan S. Ranawat Award: Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study"],"prefix":"10.1097","volume":"476","author":[{"given":"Young-Hoo","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang-Won","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Shik","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"Suppl","key":"R1-20230814","first-page":"7","article-title":"Osteoarthrosis of the knee: a radiographic investigation","volume":"277","author":"Ahlb\u00e4ck","year":"1968","journal-title":"Acta Radiol Diagn (Stockh)."},{"key":"R2-20230814","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2106\/00004623-199509000-00006","article-title":"Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note","volume":"77","author":"Arima","year":"1995","journal-title":"J Bone Joint Surg Am."},{"key":"R3-20230814","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1302\/0301-620X.86B5.14927","article-title":"Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique","volume":"86","author":"B\u00e4this","year":"2004","journal-title":"J Bone Joint Surg Br."},{"key":"R4-20230814","doi-asserted-by":"crossref","first-page":"S72","DOI":"10.3928\/01477447-20160509-21","article-title":"10-year survival of navigated versus conventional TKAs: a retrospective study","volume":"39","author":"Baumbach","year":"2016","journal-title":"Orthopedics"},{"key":"R5-20230814","doi-asserted-by":"crossref","first-page":"261","DOI":"10.2106\/JBJS.F.00601","article-title":"Navigated total knee replacement. A meta-analysis","volume":"89","author":"Bauwens","year":"2007","journal-title":"J Bone Joint Surg Am."},{"key":"R6-20230814","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy","year":"1998","journal-title":"J Rheumatol"},{"key":"R7-20230814","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2017.01.045","article-title":"Low incidence of postoperative complications with navigated total knee arthroplasty","author":"Brown","year":"2017","journal-title":"J Arthroplasty"},{"key":"R8-20230814","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1302\/0301-620X.86B3.14643","article-title":"Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomized, prospective trial","volume":"86","author":"Chauhan","year":"2004","journal-title":"J Bone Joint Surg Br."},{"issue":"Suppl 3","key":"R9-20230814","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.arth.2005.05.020","article-title":"Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis","volume":"20","author":"Crowder","year":"2005","journal-title":"J Arthroplasty"},{"key":"R10-20230814","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1302\/0301-620X.90B12.21064","article-title":"Midterm survival of a contemporary modular total knee replacement: a multicenter study of 1970 knees","volume":"90","author":"Dalury","year":"2008","journal-title":"J Bone Joint Surg Br."},{"key":"R11-20230814","doi-asserted-by":"crossref","first-page":"575","DOI":"10.2106\/00004623-199704000-00015","article-title":"Total knee replacement in young, active patients. 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A study of patients followed for a minimum of fifteen years","volume":"87","author":"Dixon","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"Suppl 2","key":"R13-20230814","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.arth.2007.05.001","article-title":"Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis","volume":"22","author":"Duffy","year":"2007","journal-title":"J Arthroplasty"},{"key":"R14-20230814","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0883-5403(97)90046-2","article-title":"5 to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger","volume":"12","author":"Gill","year":"1997","journal-title":"J Arthroplasty"},{"key":"R16-20230814","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/01.blo.0000150564.31880.c4","article-title":"Computer-assisted navigation increases precision of component placement in total knee arthroplasty","volume":"433","author":"Haaker","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R17-20230814","first-page":"1513","article-title":"Very low-dose computed tomography for planning and outcome measurement in knee replacement","volume":"88","author":"Henckel","year":"2006","journal-title":"Bone Joint J."},{"key":"R18-20230814","first-page":"3435","article-title":"Can computer assistance improve the clinical and functional scores in total knee arthroplasty?","volume":"469","author":"Hernandez-Vaguero","year":"2011","journal-title":"Clin Orthop Relat Res."},{"key":"R19-20230814","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00003086-200211000-00018","article-title":"Cementless total knee arthroplasty in patients 50 years or younger","volume":"404","author":"Hofmann","year":"2002","journal-title":"Clin Orthop Relat Res."},{"key":"R20-20230814","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00003086-198911000-00004","article-title":"Rationale of the Knee Society Clinical Rating system","volume":"248","author":"Insall","year":"1989","journal-title":"Clin Orthop Relat Res."},{"key":"R21-20230814","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/00003086-200210000-00022","article-title":"Correlation between condylar lift-off and femoral component alignment","volume":"403","author":"Insall","year":"2002","journal-title":"Clin Orthop Relat Res."},{"key":"R22-20230814","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3109\/10929080109146086","article-title":"Computer-assisted implantation of total knee prostheses: a case-control comparative study with classical instrumentation","volume":"6","author":"Jenny","year":"2001","journal-title":"Computer Aided Surg"},{"key":"R23-20230814","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s00264-008-0690-0","article-title":"Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up","volume":"33","author":"Kamat","year":"2009","journal-title":"Int Orthop"},{"key":"R24-20230814","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric estimation from incomplete observation","volume":"53","author":"Kaplan","year":"1958","journal-title":"J Am Stat Assoc."},{"key":"R25-20230814","doi-asserted-by":"crossref","first-page":"3084","DOI":"10.1007\/s11999-010-1336-2","article-title":"Osteolysis in well functioning fixed-and mobile-bearing TKAs in younger patients","volume":"468","author":"Kim","year":"2010","journal-title":"Clin Orthop Relat Res."},{"key":"R26-20230814","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2106\/JBJS.G.01700","article-title":"Kwon-O-R. Computer assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty","volume":"91","author":"Kim","year":"2009","journal-title":"J Bone Joint Surg Am."},{"key":"R27-20230814","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1302\/0301-620X.89B4.18878","article-title":"Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomized study","volume":"89","author":"Kim","year":"2007","journal-title":"J Bone Joint Surg Br."},{"key":"R28-20230814","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.2106\/JBJS.L.00142","article-title":"Computer-navigated versus conventional total knee arthroplasty. 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