title: Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  Inaccurate implantation rates of up to 30 % have been reported in cases using the conventional technique for implantation of a unicompartmental knee arthroplasty. Navigation should permit a more precise implantation, and several studies have investigated its role, albeit with a limited number of patients and inconsistent results. The aim of this meta-analysis was to compare risks of unsatisfactory outcomes in patients with navigated and conventional technique.
  
  
  METHODS
  An electronic search was performed, and ten studies were eligible and included in the meta-analysis, with a total of 258 prostheses implanted with the navigated technique and 295 with the conventional one. The following items were analysed: radiological positioning of the femoral and the tibial component in the AP and lateral view, radiological analysis of the tibiofemoral mechanical axis and the difference in operating time between the two groups. Relative risks (RR) were calculated from the reported percentages of implants outside the optimal ranges defined by the manufacturers or the study groups. Natural logarithms of the relative risks were pooled by means of random effects models.
  
  
  RESULTS
  For all the analysed radiological parameters, the RR of measurements outside the optimal ranges were less than 1 in the navigation group suggesting a reduction in the risk of outliers with navigation. The average operating time in the navigated group was 15.4 min (95 % CI: 10.2-20.6) longer than in the conventional group.
  
  
  CONCLUSIONS
  The meta-analysis shows that the use of navigation systems in UKA leads to a more precise component position. Whether the more accurate position in UKA results in a better clinical outcome or long-term survival is yet unknown. Nevertheless, as a precise implant position appears to be beneficial, the use of navigation should be recommended for UKA. The limits defined by the manufacturers for an optimal positioning are not consistent.
authors: Department of Orthopedic Surgery, Ludwig-Maximilians-University, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany, Patrick.Weber@med.uni-muenchen.de.
authors: Patrick
authors: P
authors: Weber
authors: Alexander
authors: A
authors: Crispin
authors: Florian
authors: F
authors: Schmidutz
authors: Sandra
authors: S
authors: Utzschneider
authors: Matthias F
authors: MF
authors: Pietschmann
authors: Volkmar
authors: V
authors: Jansson
authors: Peter E
authors: PE
authors: Müller
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005269:Femur / Q000601:surgery; D006801:Humans; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome