After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.