Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty

Abstract

Background: Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis.Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robotassisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. Methods:We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models.Results: A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, 20.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups.Conclusions: Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles.

Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT‐based assessment of radiological outcomes

“…Multiple studies have reported on the radiographic accuracy of RATKA compared to CTKA [18, 28]. These studies reported comparable or decreased number of outliers with RATKA.…”

“…Image‐based RATKA requires a CT‐scan imaging to map bony anatomical landmarks to preoperatively obtained image to plan bone resections and implant sizing and positioning before TKA as the imageless techniques precludes the requirement of a pre‐operative advanced CT‐scan (extra investigation) including risk of radiation exposure to the patient and intra‐operatively maps bony anatomy to guide bone resection and implant sizing and placement [1, 4, 18, 21, 28]. Though, this can be an advancement of image‐based RATKA technology that also gives information regarding the posterior side of the tibia plateau with possible hidden osteophytes and poor bone quality [20].…”

Functional alignment maximises advantages of robotic arm‐assisted total knee arthroplasty with better patient‐reported outcomes compared to mechanical alignment

“…Total knee arthroplasty (TKA) is considered an effective treatment for patients with knee osteoarthritis, reducing pain and improving daily function [27]. Recently, robotic arm-assisted TKA (RTKA) was introduced, and several studies have confirmed that RTKA results in more accurate implant positioning and fewer outliers than the conventional system [8,24]. This allows for the accurate adjustment of implant positioning, enabling surgeons to achieve their preferred alignment [6,11,28].…”