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Computer-Assisted Surgery versus Manual Total Knee Arthroplasty: A Case-Controlled Study
S. David Stulberg, MD; Mark A. Yaffe, BS; Samuel S. Koo, MD
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Aesculap). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Dec 01;88(suppl 4):47-54. doi: 10.2106/JBJS.F.00698
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The use of computer-assisted surgery by orthopaedists experienced in the performance of total knee arthroplasty results in better overall limb and implant alignment and fewer outliers as compared with the findings after manual total knee arthroplasty1-8. However, we are not aware of any studies that have established whether these improvements in alignment accuracy are associated with superior clinical and patient-perceived functional results.In addition, we are not aware of any studies that have examined the potential training effects that occur when experienced surgeons use these techniques. Computer-assisted surgery may offer experienced surgeons the potential to improve their technique and their ability to perform total knee arthroplasty manually through intraoperative training effects provided by working with computer-assisted surgery. For example, in severely obese patients, proper limb alignment may not be readily apparent on initial visualization or with use of a standard mechanical alignment system. However, through the use of a navigation system, it is possible to obtain real-time alignment measurements during the course of the surgical procedure. The intraoperative feedback provided by the navigation system offers the surgeon the ability to adjust his or her perception and assessment of proper limb and implant alignment. This training effect may result in a more accurate total knee arthroplasty performed with use of manual instrumentation.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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