Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objectives Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. Methods We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR − 0.82; 95% CI, − 1.027 to − 0.58, p value < 0.00001) and mechanical restoration (OR − 0.95; 95% CI, − 1.49 to − 0.41, p value < 0.0006). While knee range of motion (OR − 2.23; 95% CI − 4.89–0.43, p value 0.1) and femoral prosthesis position (OR − 0.98; 95% CI, − 2.03–0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. Conclusion This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. Level of evidence I.

Computerized Versus Traditional Approaches for Total Knee Arthroplasty: A Quantitative Analysis of Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index

“…Despite variations in methodologies and patient populations across these studies, the consistent lack of significant differences in measures such as Knee Society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores underpins the importance of our findings. While computer‐assisted techniques may offer advantages in terms of alignment precision and intraoperative decision‐making, 16 our results suggest that these benefits may not translate into superior functional outcomes or patient‐reported satisfaction in the short to medium term. However, it is essential to acknowledge the limitations inherent in these studies, such as relatively short follow‐up periods and variations in sample sizes.…”

Robotic Total Knee Arthroplasty: An Update

“…As R-TKR is considered to improve ROM at short-term follow-up [ 44 , 65 ], it may be also associated with improved early patient satisfaction compared to C-TKR. However, well-conduced RCTs at longer follow-up (more than 10 years) fail to find any statistically significant differences in term of knee ROM, PROMs, and overall survivorship between R-TKA and C-TKA [ 8 , 66 ].…”

“…There are no differences in revision rate for aseptic loosening between R-TKA and C-TKA. The cumulative survival rate, excluding septic revisions, range from 97.4% to 96.6%, and Kaplan–Meier survival analysis showed no statistically significant differences at 10-year follow-up [ 8 , 46 , 47 ].…”

“…Results are conflicting and still unclear. Although several comparative studies showed the improvement of component and limb alignment with R-TKA compared with C-TKA [ 5 , 6 ], no statistical differences have been reported according to clinical outcome scores, aseptic loosening, and overall survivorship [ 7 , 8 ].…”

Robotic Surgery for Elective Repair of Visceral and Renal Artery Aneurysms: A Systematic Review

“…The emergence of robotic-assisted laparoscopic surgery (RALS) has changed the approach to many diseases in the field of abdominal surgery, urologic surgery, and orthopedics [ 1 , 2 , 3 ]. Although its application to vascular surgery is still limited to selected anecdotal cases, the treatment of visceral artery aneurysms (VAA) is a field where robotic surgery is most promising.…”