Strong evidence supports not using intraoperative navigation in total knee arthroplasty (TKA) because there is no difference in outcomes or complications.

Rationale
Three high quality studies (Thiengwittayaporn 2013, Seon 2009, Kiss 2012) and two moderate quality studies (Lutzner 2010, Dutton 2008) compared surgical navigation to conventional instrumentation for total knee arthroplasty. At follow-up greater than 90 days, there were no differences in patient reported quality of life outcomes (EQ-5D, SF-36 Mental Component Summary), patient reported knee function (Oxford Knee Score, Knee Society Score, and WOMAC), and pain (WOMAC). 

Four high quality studies (Lutzner 2008, Church 2007, Chin 2005, Blakeney 2011) and one moderate quality study (Kalairajah 2005) were all consistent in their findings that length of surgery favored no surgical navigation. A meta-analysis on infection found no difference in infection risk comparing surgical navigation to conventional instrumentation for total knee arthroplasty.

The work group recognizes that there are scenarios where computer navigation theoretically could be considered, such as malunions, intramedullary implants, or in training scenarios, but the evidence is insufficient to make a recommendation.
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  2. Chin,P.L., Yang,K.Y., Yeo,S.J., Lo,N.N. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 2005/8; 5: 618-626
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  6. Kiss,R.M., Bejek,Z., Szendroi,M. Variability of gait parameters in patients with total knee arthroplasty. Knee Surg Sports Traumatol.Arthrosc. 2012/7; 7: 1252-1260
  7. Lutzner,J., Gunther,K.P., Kirschner,S. Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol.Arthrosc. 2010/10; 10: 1339-1344
  8. Lutzner,J., Krummenauer,F., Wolf,C., Gunther,K.-P., Kirschner,S. Computer-assisted and conventional total knee replacement: A comparative, prospective, randomised study with radiological and CT evaluation. Journal of Bone and Joint Surgery - Series B 2008; 8: 1039-1044
  9. Seon,J.K., Park,S.J., Lee,K.B., Li,G., Kozanek,M., Song,E.K. Functional comparison of total knee arthroplasty performed with and without a navigation system. Int.Orthop 2009/8; 4: 987-990
  10. Thiengwittayaporn,S., Kanjanapiboonwong,A., Junsee,D. Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty. Journal of orthopaedic surgery and research 2013; 0: 37-