ORTHOPEDICS THIS WEEK VOLUME 14, ISSUE 23 | JULY 17, 2018 16 a higher rate of revision. Data from the Australian Registry over 9 years, shows with CAS the revision rates have gone down significantly.
Within our own series, navigation outcomes were much better than conventional surgery. Before CAS where we had done conventional surgery, we had 15 revisions for mechanical causes in 1,000 patients. After navigation we had only 3 revisions in the first 1,000 cases and just 1 revision in the next 4,000 cases with navigation.
Lastly, navigation is cost effective. A recent paper from Norway( Gothesen, et al., BMC Musculoskeletal Disorders 2013) looked at the economic models to evaluate cost effectiveness. In order to be cost effective navigation needs to increase the total knee survival rate by 1 % in centers doing more than 25 total knees annually. If the center is doing more than 250 total knees a year, then the survival rate needs to increase by just 0.1 % for navigation to be cost effective.
Navigation outscores conventional surgery in terms of achieving the alignment you want; getting the balance that you want. Better function. Reduced emboli, reduced risk of revision and it’ s cost effective.
Is navigation lost in space? No! It is out of this world. You’ ve got to use it and be ready for a joint space odyssey.
Moderator Thornhill: These were 2 great talks. Rob, you’ ve used it before. When would you or when do you use navigation?
Dr. Trousdale: Yes, I used it for a period of time in a consecutive series of knees and I was happy. I had precise tools and accurate tools, relatively quick for me. The problem is a couple of things.
We jumped from no intra-operative tool, skipping the X-ray part, and going straight to this expensive computer. While CAS is worthwhile in complex cases, the problem is for each individual patient when you look at sagittal alignment, axial alignment and balance, we really don’ t know what the balance should be for an 85-year-old patient who needs a total knee versus a 60-yearold. Until we know the target, I’ m not sure we’ re going to realize the benefits of intra-operative computers and navigation.
Moderator Thornhill: Let’ s say you’ re not very experienced and the CAS learning curve is 40 cases to really become good. Will navigation shorten your learning curve?
Dr. Mullaji: I think so. You know exactly what to do. You can titrate your soft tissue releases. You can check your
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