Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes—A Single Surgeon Experience

Abstract

Background This study sought to evaluate the patient experience and short-term clinical outcomes associated with the hospital stay of patients who underwent robotic arm-assisted total knee arthroplasty (TKA). These results were compared with a cohort of patients who underwent TKA without robotic assistance performed by the same surgeon prior to the introduction of this technology. Materials and Methods A cohort of consecutive patients undergoing primary TKA for the diagnosis of osteoarthritis by a single fellowship trained orthopaedic surgeon over a 39-month period was identified. Patients who underwent TKA during the year that this surgeon transitioned his entire knee arthroplasty practice to robotic assistance were excluded to eliminate selection bias and control for the learning curve. All patients received the same prosthesis and postoperative pain protocol. Patients that required intubation for failed spinal anesthetic were excluded. A final population of 492 TKAs was identified. Of these, 290 underwent TKA without robotic assistance and 202 underwent robotic arm-assisted TKA. Patient demographic characteristics and short-term clinical data were analyzed. Results Robotic arm-assisted TKA was associated with shorter length of stay (2.3 vs. 2.6 days, p < 0.001), a 50% reduction in morphine milligram equivalent utilization (from 214 to 103, p < 0.001), and a mean increase in procedure time of 9.3 minutes (p < 0.001). There was one superficial infection in the nonrobotic cohort and there were no deep postoperative infections in either cohort. There were no manipulations under anesthesia in the robotic cohort while there were six in the nonrobotic cohort. Additionally, there were no significant differences in emergency department visits, readmissions, or return to the operating room. Conclusion This analysis corroborates existing literature suggesting that robotic arm-assisted TKA can be correlated with improved short-term clinical outcomes. This study reports on a single surgeon's experience with regard to analgesic requirements, length of stay, pain scores, and procedure time following a complete transition to robotic arm-assisted TKA. These results underscore the importance of continued evaluation of clinical outcomes as robotic arthroplasty technology continues to grow.

Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis

“…1 ) [ 12 , 24 , 35 , 42 ]. A list of the 16 studies which met the inclusion criteria are illustrated in Table 1 [ 4 , 18 – 20 , 23 , 25 , 28 , 30 – 32 , 36 , 44 , 49 – 52 ]. Nine studies were identified from Medline and PubMed, and seven additional studies from Google Scholar (Table 1 ).…”

“…Six studies reported on the complications between RATKA and mTKA groups (Table 6 ) [ 4 , 19 , 20 , 25 , 36 , 49 ]. The most reported complications were arthrofibrosis requiring MUA, superficial or deep infections and wound dehiscence.…”

Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy

“…The time required to perform the robotic-specific surgery steps is similar to the time required for the setup and handling of the alignment guides and cutting blocks used to perform alignment during the conventional method. Previous studies have shown consistent findings [7,24], although two studies reported significantly longer surgery times for roboticassisted TKA [25,26].…”

A Newly Designed “SkyWalker” Robot Applied in Total Knee Arthroplasty: A Retrospective Cohort Study for Femoral Rotational Alignment Restoration

“…The learning curve of the two studies focused on the first 10–15 patients, and the operative times of the remaining patients showed no difference. 28 , 29 …”

“…The RATKA group requires longer operative times in the early stages of surgery as surgeons required more time to learn and adapt to the new technique. Once they become proficient in COTKA, after adaptive learning and training of 20 cases, the time spent on RATKA should not be different from that of COTKA 28,29 . Fleischman et al 30 .…”