Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?

41 randomized controlled trials (RCTs) or quasi-RCTs were identified to examine whether computer-assisted surgery (CAS) would lead to superior mechanical leg axis and implant positioning compared to conventional technique in patients with primary total knee arthroplasty (TKA). Results for leg axis and coronal positioning of femoral and tibial components indicated a statistically significant reduction in the number of patients with malalignment in the CAS group (if the outlier cut off value is +/-3 or 2 degrees in the coronal and sagittal planes, respectively). However, it was indicated that the accuracy of tibial component alignment in the sagittal plane was not enhanced.