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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