A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

Abstract

Background While technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA). Methods Patients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann–Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables. Results Of the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups. Conclusions TA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient. Level III evidence Retrospective cohort study.

Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study

“…Despite advancements in both technology and surgical techniques of MA TKA, patient dissatisfaction with post-TKA pain relief and overall outcomes remains high; a substantial proportion of patients report knee abnormalities [ 1 , 2 , 5 , 30 , 31 ]. KA TKA seeks to restore the anatomy of each individual patient; the kinematic and clinical outcomes are better than those of MA TKA [ 14 , 15 , 16 , 18 ].…”

The trend and future projection of technology‐assisted total knee arthroplasty in the United States

“…First, our prediction is limited by the current absence of consensus on the superiority of technology-assisted versus conventional TKA. [7][8][9][10][11] The technology adoption in surgical field is dynamic and is likely to be continually influenced by many factors, such as clinical outcomes, surgical volume, and the steepness of the learning curve. Thus, the actual rate of adoption may differ from our prediction here.…”

“…On the other hand, some patients may be sceptical about the real benefit of technology, and may believe that experienced surgeons can perform operations competently with or without the assistance of technology. Meanwhile, whether the improved technical outcomes can translate to improved patient satisfaction or clinical outcomes remains unknown 7–11 . These uncertainties, coupled with the surgeons' longer learning curve, additional operative time, and higher equipment expense, have made the adoption of technology‐assisted operations inconsistent across different populations and different regions 12 .…”

“…Meanwhile, whether the improved technical outcomes can translate to improved patient satisfaction or clinical outcomes remains unknown. [7][8][9][10][11] These uncertainties, coupled with the surgeons' longer learning curve, additional operative time, and higher equipment expense, have made the adoption of technology-assisted operations inconsistent across different populations and different regions. 12 Thus, an understanding of the factors affecting healthcare-related technology adoption can have important policy implications.…”

Robotics and Navigation Do Not Affect the Risk of Periprosthetic Joint Infection Following Primary Total Hip Arthroplasty

“…T he use of technological aids during total hip arthroplasty (THA) continues to grow in popularity throughout the United States 1,2 . Although the majority of THAs performed in the United States employ conventional methods, the utilization of technological aids such as computer navigation and robotic assistance is projected to grow to 25% in 2025 and 67% in 2030 3 . Several comparative studies have suggested that the use of computer navigation and robotic assistance leads to more accurate component positioning compared with conventional methods, leading to a lower rate of postoperative instability [4][5][6][7][8][9][10] .…”