No difference in quality-of-life outcomes in the first 7 years following primary total knee arthroplasty performed using computer navigation versus conventional referencing
Title
No difference in quality-of-life outcomes in the first 7 years following primary total knee arthroplasty performed using computer navigation versus conventional referencing: A propensity score-matched analysis
Investigators
Jason Trieu BBiomed 1, Chris Schilling 2, Tim Spelman 3, Michelle M Dowsey 4, Peter F Choong 5
Abstract
Background: Computer navigation techniques can potentially improve both the accuracy and precision of prosthesis implantation in total knee arthroplasty (TKA), but its impact on quality-of-life outcomes following surgery remains unestablished.
Methods: An institutional arthroplasty registry was queried to identify patients with TKA performed between 1st January 2007 and 31st December 2019. Propensity score matching based on demographical, medical, and surgical variables was used to match computer navigated to conventionally referenced cases. The primary outcomes were Veterans-RAND 12 Item Health Survey scores (VR-12 PCS and MCS), Short Form 6 Dimension utility values (SF6D), and quality-adjusted life years (QALYs) in the first 7 years following surgery.
Results: A total of 629 computer navigated TKAs were successfully matched to 1351 conventional TKAs. The VR-12 PCS improved by a mean of 12.75 and 11.94 points in computer navigated and conventional cases at 12-month follow-up (p=0.25), and the VR-12 MCS by 6.91 and 5.93 points respectively (p=0.25). The mean VR-12 PCS improvement at 7-year follow-up (34.4% of the original matched cohort) for navigated and conventional cases was 13.00 and 12.92 points (p=0.96), and for the VR-12 MCS was 4.83 and 6.30 points respectively (p=0.47). Mean improvement in the SF-6D utility score was 0.164 and 0.149 points at 12 months (p=0.11), and at 7 years was 0.115 and 0.123 points (p=0.69). Computer navigated cases accumulated 0.809 QALYs in the first 7 years, compared to 0.875 QALYs in conventionally referenced cases (p=0.65). There were no differences in these outcomes amongst a subgroup analysis of obese patients (body mass index >=30kg/m2).
Conclusion: The use of computer navigation did not provide an incremental benefit to quality-of-life outcomes at a mean of 2.9 years following primary total knee arthroplasty performed for osteoarthritis when compared to conventional referencing techniques.
Keywords: computer assisted; computer navigation; patient outcomes; quality of life; total knee arthroplasty; total knee replacement.
