Abstract
Computer navigation has been introduced as an adjunct to Total Knee Arthroplasty (TKA) to assure precision positioning, accurate bone resection and optimal component alignment. Using Computer Assisted Navigation in TKA was a hotly debated issue in United States and elsewhere. Although Computer Navigation has progressed from the 1st generation to the current 3rd generation system, there are still no clearly tangible, apparent long term clinical benefits.
There is some evidence that using Computer Assisted Surgery may lower the incidence of malalignment of mechanical limb axis compared to conventional component placement methods, but it is unclear whether this marginal benefit will translate to concrete positive long term outcomes. AAHKS survey results indicated that the majority of Orthopedic Surgeons were not using computer navigated surgical techniques. The implementation of CAS met with so many hurdles and obstacles because its approach consumes more time and a long learning curve, which translates to added cost and complexity. It is also labor and equipment intensive but only increases accuracy in the “right” hands. Lack of popularity for CAS has induced the innovation of Patient Specific Jigs which has been proven to be extremely accurate, efficient with respect to time and allows surgeons to navigate the operation prior to the procedure.
Since CAS remains unpopular in the US, it would be even less popular in Asia for the obvious reasons of high cost, lack of experts to handle technical difficulties, lack of publicity, and the paucity of beneficial expert testimonies. The “Better, Cheaper, Faster” culture is fully ingrained in the minds of most Asian Arthroplasty surgeons and CAS would seem to only fulfill the “Better”, but not the “Cheaper and Faster” expectations in most hands.
