A Systematic Review and Meta-Analysis of Conventional Versus Robotic-Assisted Total Knee Arthroplasty

Abstract

This study aims to compare the outcomes and advantages of total knee arthroplasty (TKA) performed using conventional surgical techniques with those conducted using robotic-assisted methods in terms of operation time, Oxford knee score, range of motion, tourniquet time, and Western Ontario and McMaster Universities Arthritis index. We performed a literature search through five databases, namely, PubMed, Cochrane Central, Scopus, Embase, and Web of Science, from inception until July 3, 2023. Randomized clinical trials (RCTs) and cohorts comparing conventional TKA with robotic-assisted TKA were included. The risk of bias of the included RCTs was determined using the Cochrane risk of bias tool and the National Institutes of Health tool for cohort studies. We conducted a meta-analysis using Review Manager 5.4. To analyze continuous data, we calculated the mean difference (MD) along with its corresponding 95% confidence interval (CI). By synthesizing data from a comprehensive analysis, the study unveiled noteworthy distinctions between robotic-assisted arthroplasty and conventional arthroplasty across critical parameters. First, a substantial alteration in the hip-knee-ankle (HKA) angle was observed, with the robotic-assisted approach demonstrating a significant difference (MD = 0.84, 95% CI = 0.25-1.43, p = 0.005). Second, in terms of operative time, a notable reduction in surgical duration was noted with conventional TKA (MD = 16.85, 95% CI = 8.08-25.63, p = 0.0002). The assessment of tourniquet time exhibited a significantly longer duration for robotic-assisted arthroplasty (MD = 35.70, 95% CI = 27.80-43.61, p < 0.001). Our findings indicate that conventional TKA outperforms robotic-assisted TKA, primarily due to its shorter operative and tourniquet times, along with a more favorable change in the HKA angle. However, it is worth noting that robotic-assisted TKA showed a slight advantage in pain outcomes, although this advantage was not statistically significant. To gain a more comprehensive understanding, we recommend conducting a largescale randomized controlled trial that directly compares both TKA methods. This trial should evaluate costs and long-term outcomes while ensuring consistent follow-up durations among studies. Such an approach would greatly assist orthopedic decision-making and contribute to improved TKA outcomes.

Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective

“…These main factors were also identified in our patient lot, either alone or combined; however, the analysis of the clinical parameters and risk factors was outside the scope of this paper. Nevertheless, while significant progress in rTKA indications, surgical planning and approach, robotic-assisted surgical options, management, and follow-up of patients has been recorded throughout the last 20 years, the definitive role and contribution of these improvements to primary TKA failure remain to be established [69][70][71][72][73][74][75][76][77].…”

A commentary on ‘Associations of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial’

“…Finally, the study used a multicenter study, which can significantly improve the efficiency of the study, reduce the bias of a single center, and enhance communication between researchers in different regions, which is worthwhile for all clinical researchers. However, there are differences in the form of surgery and surgical experience between different surgical teams, which will have a greater impact on the patient’s surgical healing, thus affecting the results of the study 7 .…”