Computer-based pre- and intra-operative planning modalities for Total Knee Arthroplasty: A comprehensive review

Abstract

Since the introduction of total knee arthroplasty (TKA) into modern medicine, many types of digital pre- and intra-operative planning methods have been introduced. Due to the abundance of planning modalities for TKA, physicians are posed with the challenge of which type to implement into their daily practice. In the current fast-paced and research-driven medical environment it is important to understand the differences between the computer-based pre- and intra-operative planning modalities for TKA. The following databases were searched: MedLine, EMBASE, Web of Science, and the Cochrane Library. All articles were independently reviewed by the two reviewers (DS, ID). The following data were extracted, if available: study ID, country of conduction, type of planning modality or modalities, and the use and explanation of historical and currently employed pre- and intra-operative planning modalities for TKA. 39 studies were included into the systematic review. Computer assisted surgery (CAS) represents a surgical concept where computer technology is used for surgical planning. CAS for TKA was introduced in the late 1980s. Subsequently, three different types of CAS were developed to plan TKA. The first type of CAS, computer integrated instruments, also known as CAS navigation, provides a real-time view of anatomy and marked surgical instruments intra-operatively. For the second type of CAS, rapid prototyping, or 3D printing, was derived from CAS technology in which the development of patient specific instrumentation (PSI) for TKA followed. Furthermore, CAS aided the evolution of the third type of CAS for TKA: robotics. With a high demand for TKA surgery, the challenge to achieve more accurate alignment, improved prosthesis survival, and improved patient satisfaction rates is a very topical one. Planning modalities for TKA were developed to address this demand. This comprehensive systematic review showed that the monumental development of digital planning modalities for TKA has led to a vast amount of well-researched options that surgeons can choose from and use in daily practice.