Abstract
Surgical navigation in joint replacement has been developed for more than 10 years. After the initial enthusiastic period, it appears that few surgeons have included this technology into their routine practice. The reasons for this backflow are lack of evidence of any clinical superiority for navigation implanted prostheses, higher costs and longer operative time. However, navigation systems have evolved, and might still belong to the future of joint replacement.
Although most studies did not observe clinically relevant differences between navigated and conventional joint replacement, some registry studies identified significant advantages in favor of navigation: less blood loss, less early revision, subtle but relevant functional improvement… If TKR may be more forgiving, there is a trend to use less invasive implants (UKR), which are technically more demanding and may benefit from navigation. Ligamentous balancing may be more accurate and more reproducible with the help of navigation, and in that way patient specific templates may benefit from navigation. New techniques (short stem hip implants, hip resurfacing) have a relevant learning curve which may be fastened with navigation support.
Another key point may be the individual joint reconstruction: anatomy is different from one patient to the other, and navigation may help detecting these subtle differences to adapt a more physiological joint reconstruction, instead reconstructing all joints on the same model.
New navigation systems now available are designed in a more user-friendly style, with more straightforward workflow, and may be adapted to every surgeon's need.
Finally, navigation system may act as documentation and quality control system for health care providers, as well as a very powerful research tool for scientists and manufacturers.
