hta_ knee intro.qxp - Ministero della Salute

new sequentially cross-linked polyethylene, minimally invasive TKR, computer-assisted or navigated
TKR, and gender-specific designs.
However, as in all the therapeutic interventions, surgeons should use the practice of evidence-based
medicine to adopt those surgical techniques that have been proven safe and efficacious
by long-term prospective outcome studies (Richmond, 2009). Unfortunately, the marketing strategies
also play their role and may guide the choices of surgeons and hospitals.
Minimally invasive procedures, are in general, considered very technically demanding.
Computer navigation, that use precise identification systems of bony anatomic landmarks, may
be used in combination with small incisions to allow the surgeon to obtain a better alignment of
the prosthesis. Conversely, computer navigation requires a learning curve and is more expensive
and time-consuming that the traditional surgery.
Recently new prostheses designs are introduced and marketed as “gender specific”. The rationale
of these devices is based on the anatomic variations between men and women. To date, there
is no evidence to support an advantage of these gender-specific devices for women. When the
literature for traditional TKR is reviewed for outcomes based on sex, the risk of failure is not higher
in women than in men (Rankin, 2008).
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