Computer and Robotic Assisted Orthopaedic Knee Arthroplasty Surgery: Did CAOS technologies have an impact on the mainstream principles and concepts in the orthopaedic knee forum? A case study on alignment and balancing for TKA.

Computer technology is ubiquitous and relied upon in virtually all professional activities. Confounding this is orthopaedic surgery where less than 5% of surgeons are using computer-assisted technologies routinely. However, the impact of Computer Assisted Orthopaedic Surgery (CAOS) may go beyond adoption in theatre.We searched pubmed for all knee arthroplasty papers concerning knee alignment and balancing between 1976 and 2016, dividing the results into those related to CAOS and those not. Results were grouped by technology.Between 2001 and 2008, the number of publications regarding knee navigation multiplied by 20 mainly focused on this topic of alignment and balancing, with alignment papers paralleled between navigation and non-navigation until 2010. After 2010, when navigation publications decline the number of articles related to the knee alignment and balancing without navigation increased granting the value of assessing accurately intraoperative kinematic data to improve Total Knee Arthroplasty (TKA) outcomes. From 2008, patient specific instrumentation (PSI) publications greatly increase, but navigation decreases, while robotic publications rise from 2014.CAOS surgery publications on the search topic of alignment and balancing increased greatly between 2001 and 2018 which may suggest the impact of CAOS technology on this important knee orthopaedic forum segment.