Computer assisted knee replacement surgery: is the movement mainstream?

The first computer-assisted Total Knee Arthroplasty (TKA) was performed in 1997. The FDA approved computer assisted knee arthroplasty systems used in the early 2000s. Since then, surgeons and institutions all over the world have gradually adopted the technology. While the computer holds an importance place in the majority of workspaces across all industries, computer-assisted surgical technique has yet to become the preferred tool of the orthopaedic surgeon. Why has "e-instrumentation" not yet substituted conventional instrumentation in TKA orthopaedic surgery? In this article, we argue that main reasons which oppose the use of this technology are based on inaccurate or misleading observations. We isolated the factors likely to explain such opposition to this innovation: current results of total knee replacement, surgeon age, operative time, system ergonomics, cost for users, and cost for suppliers and "disruptive" innovations. Other factors such as surgeon habits, hospital environment and available assistance for support, although relevant, are not discussed. We assessed the advantages and drawbacks, costs and benefits of this technology to assess whether or not this opposition is justified. Finally, we explored the reasons why such a technology may impel surgeons to use this technique or any "related technologies" in the future. The main factors limiting TKA navigation spreading amongst orthopaedic surgeons are ergonomics and economics. Other factors, such as current TKA outcomes and surgeon's age are fallacious arguments in the rebuttal of CAS system use. Computer assisted knee arthroplasty surgery is not yet mainstream, but TKA will not escape technological progress.