Artroplastia total de rodilla navegada versus convencional; estudio prospectivo a 3 años de seguimiento

espanolObjetivo La navegacion en la artroplastia total de rodilla (ATR) ha demostrado obtener una alineacion de implantes mas precisa comparada con la instrumentacion convencional. Aunque se deberia esperar una supervivencia mas prolongada de los implantes y resultados clinicos superiores mediante la cirugia navegada, la evidencia disponible no apoya esta hipotesis. El objetivo de este estudio fue comparar los resultados clinicos y radiologicos de la ATR navegada con la ATR convencional tras un seguimiento de 3 anos bajo la hipotesis de que la navegacion proporcionaria mejores resultados. Material y metodo Estudio prospectivo multicentrico de 119 pacientes intervenidos de ATR navegada y 80 pacientes con instrumentacion convencional. Todos ellos fueron evaluados preoperatoriamente, a los 3, 12, 24 y 36 meses. El analisis incluyo los cuestionarios Western Ontario and McMaster's Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) y Short Form-12 Health Survey (SF-12), ademas de la evaluacion radiografica. Resultados Todas las puntuaciones clinicas mejoraron para todos los pacientes durante el seguimiento, pero fueron significativamente mejores en el grupo de navegacion. El porcentaje de pacientes que mostraban un angulo mecanico femorotibial comprendido entre 3° de varo y 3° de valgo fue significativamente mayor en el grupo de ATR navegada (93%) que en el grupo de ATR convencional (71%) (p Conclusiones El uso de la cirugia asistida por ordenador en la ATR proporciona una alineacion mecanica mas precisa y resultados funcionales superiores a corto plazo en comparacion con la cirugia convencional. EnglishObjective Computer-assisted surgery application in total knee arthroplasty (TKA) has shown more accurate implant alignment compared with conventional instrumentation and is associated with more homogeneous alignment results. Although longer implant survival and superior clinical outcomes should be expected from navigated TKA, currently available evidence does not support this hypothesis. The aim of this study was to compare navigated TKA with conventional TKA regarding clinical and radiological outcomes after a 3-year follow-up under the hypothesis that navigated TKA would provide better outcomes than conventional TKA. Material and method In a prospective multicentre study, 119 patients underwent navigated TKA and 80 patients received conventional instrumentation. Patients were evaluated at the baseline and at postoperative months 3, 12, 24, and 36. Analysis included the American Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF12) Health Survey, and radiographic assessment. Results All clinical scores improved significantly for all patients during the follow-up but were significantly better in the navigation group. The percentage of patients showing a mechanical axis between 3° of varus and 3° of valgus was significantly higher in the ATR group (93%) than in the conventional TKA group (71%) (P Conclusions The use of computer-assisted surgery in TKA provides more accurate mechanical alignment and superior short-term functional outcomes compared to conventional TKA.