Robot-assisted surgery in total knee arthroplasty: trauma maker or trauma savior? A prospective, randomized cohort study

Abstract

Background Robotic assistance has been increasingly employed to improve the operative precision in modern knee surgery. The purpose of the study was to evaluate the trauma effect of one of the first domestically developed orthopedic surgical robots in China in a clinical trial of robot-assisted total knee arthroplasty (RA-TKA). Methods A total of 33 patients who underwent unilateral TKA for end-stage osteoarthritis were randomized to receive RA-TKA (17 cases) or conventional manual TKA (CM-TKA) in our institution in 2020. The trauma effects of the 4 main indicators with 48 sub-indicators in terms of subsectional operative time, inflammation and coagulation markers, physical and radiographical analyses of osteotomy deviation, and postoperative comfort were analyzed. Results Subsectional operative time analysis showed that the times for bone cutting and gap balancing with RA-TKA were 5.3 and 2.2 min shorter than those with CM-TKA ( p = 0.010, p = 0.02), respectively. Arterial blood gas indicators (partial pressure of carbon dioxide, partial pressure of oxygen and SO 2 ) 24 h after RA-TKA, as well as the white blood cell count and neutrophil ratio, were significantly lower than those after CM-TKA ( p < 0.05). Inflammatory markers at 72 h after surgery showed the increments of C-reactive protein, erythrocyte sedimentation rate and D-dimer of RA-TKA declined by 180.7, 22.0 and 1050.0% ( p < 0.05), respectively, referenced to the preoperative baseline values, as compared to CM-TKA. Mechanical deviation distribution exhibited percentages of region I errors for RA-TKA and CM-TKA of 76.5% and 27.1% ( p = 0.000), respectively, and the success rates of one-time osteotomy were 94.1% and 62.5% ( p = 0.039), respectively. Radiographical verification showed RA-TKA was more conducive to achieving mechanical alignment and ideal tibial component azimuths. Postoperative efficacy showed that patients were more comfortable after RA-TKA in terms of reduced administration of tranexamic acid, hydrocortisone and the utilization rate of temporary intensive opioid analgesics. No statistical difference in patient-reported outcome measures and complications were recorded between the two groups during continuous observation. Conclusions Compared with CM-TKA, RA-TKA decreases rather than increases trauma. It might shorten the time required for bone cutting and gap balancing, reduce mechanical errors related to the osteotomy and prosthesis position, and improve the accuracy of the mechanical alignment reconstruction. RA-TKA is also favorable in promoting postoperative comfort and minimizing inflammatory response and drug consumption. Trial registration The Chinese Clinical Trial Registry (ChiCTR2000031282) ap...

Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty

“…The full-text version of the remaining 44 articles was assessed for eligibility; of these, 32 were excluded for the following reasons: 10 were not RCTs, 8 did not have data on the specified outcomes of interest, 8 were review articles, 3 included UKAs only, 2 did not have a control group, and 1 was not published in the English language. Ultimately, 12 RCTs 15-26 with a total of 2,591 patients with knee OA were included in the final analysis (Fig. 1).…”

Mapping knowledge landscapes and emerging trends of robotic-assisted knee arthroplasty: A bibliometric analysis

“…This discord has raised concerns about the routine application of robotic technology. [20,39,43,46,[51][52][53] For instance, Maritan, Guido et al [54] exhibited excellent clinical outcomes and revision rates in both robotic arm-assisted and manual techniques for lateral UKA, with no discernible clinical disparities in medium-to long-term follow-up results. Considering the longterm horizon, as the robotics industry strives to attain heightened productivity, precision, and cost reduction, [43] the crux lies in achieving enhanced clinical outcomes while preserving efficiency-a pivotal concern in the future trajectory of robotic-assisted knee arthroplasty.…”

“…[18] Surgical errors, encompassing inadequate calibration and positioning, can adversely impact prosthesis survival rates. [17,19,20] Since the introduction of the first surgical robotic system in 1985, robotic technology has found wide-ranging adoption in the medical sphere. [21] Within the realm of orthopedics, robotic-assisted total knee arthroplasty has emerged as a notable advancement.…”

Robotic systems in total knee arthroplasty: current surgical trauma perspectives

“…There are factors that favour and oppose decreasing the surgical time for RA-TKA. As the authors of the commented article concluded, robot-assisted bone preparation and avoidance of unnecessary soft tissue release could decrease the surgical time that would otherwise be prolonged [ 1 ]. This conclusion partially echoes the literature reporting no difference in postoperative trauma, although increased registration time and length of incision could result in surgical trauma [ 28–30 ].…”

“…A prospective, randomized cohort study by Xu et al . https://doi.org/10.1093/burnst/tkac034 [ 1 ] is a valuable attempt to improve the evaluation of perioperative surgical trauma. This study has added new knowledge to the current concept of surgical trauma in RA-TKA.…”