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Reply to the Letter to the Editor

2017 Chitranjan S. Ranawat Award

Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study

Kim, Young-Hoo MD; Park, Jang-Won MD; Kim, Jun-Shik MD

Clinical Orthopaedics and Related Research®: June 2018 - Volume 476 - Issue 6 - p 1364
doi: 10.1007/s11999.0000000000000306
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Y.-H. Kim, The Joint Replacement Center, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea

J.-W. Park, J.-S. Kim, The Joint Replacement Center, MokDong Hospital, Seoul, Republic of Korea

Y.-H. Kim, The Joint Replacement Center, Ewha Womans University, SeoNam Hospital, #20, Sinjeongipen 1-ro, YangCheon-gu, Seoul 158-070, Republic of Korea, Email: younghookim@ewha.ac.kr

(Kim YH, Park JW, Kim JS. 2017 Chitranjan S. Ranawat Award: Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study. Clin Orthop Relat Res. 2018;476:6-15).

The authors certify that neither they, nor any members of their immediate families, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Received March 12, 2018

Accepted March 23, 2018

To the Editor,

We deeply appreciate Dr. Hazratwala for his interest in our article, but we would like to clarify his interpretation of our study results [2].

In our conclusion, we wrote: “Unless another study at long-term followup identifies an advantage to survivorship, pain, or 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 [1]) and attendant costs” [2]

About 20% of our patients had mild pain after TKA, but they were satisfied with the procedure. Remaining mild pain after TKA is attributable to multifactorial causes, including pain from spinal stenosis, pes anserinus bursitis, and mild subluxation of patellar component due to weak quadriceps muscle [2].

In our previous study [3], we indicated that the absence of severe malalignment (≥ 6°) in the conventional TKA group was attributable to similar clinical results as in the computer-assisted TKA group. We observed the same findings in the current study.

We feel that navigation TKA can be applied as an educational teaching tool; for example, it might be particularly useful in a cadaver workshop. But unless another study demonstrates clear advantages—which might occur in subpopulations such as Dr. Hazratwala suggests—we do not recommend its routine use.

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References

1. Brown MJ, Matthews JR, Bayers-Thering MT, Phillips MJ, Krackow KA. Low incidence of postoperative complications with navigated total knee arthroplasty. J Arthroplasty. [Published online ahead of print February 3, 2017]. DOI: 10.1016/j.arth.2017.01.045.
2. Kim YH, Park JW, Kim JS. 2017 Chitranjan S. Ranawat Award: Does computer navigation in knee arthroplasty improve functional outcomes in young patients? A randomized study. Clin Orthop Relat Res. 2018;476:6–15.
3. Kim Y-H, Park J-W, Kim J-S. Computer-navigated versus conventional total knee arthroplasty. A prospective randomized trial. J Bone Joint Surg Am. 2012;94:2017–2024.
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