What are the benefits of robotic-assisted total knee arthroplasty over conventional manual total knee arthroplasty? A systematic review of comparative studies

Abstract

Total knee arthroplasty (TKA) is a highly successful operation that improves patients’ quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with the functional outcomes. Robotic TKA has gained increased attention and popularity in order to improve patient satisfaction and implant survivorship by increasing accuracy and precision of component implantation. The current systematic review was run in order to compare implant survivorship, complication rates, clinical outcomes, and radiological outcomes between robotic-assisted TKA (RA) and conventional manual TKA (CM). Articles were referenced from the US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews. Nine comparative studies with 1199 operated knees in 1159 patients were included, 614 underwent active or semiactive robotic-assisted TKA compared to 585 CM-TKA. Improvements in the RA group were reported for early functional outcomes, radiographic outliers (RA 16% vs CM 76%) and radiolucent lines (RA 0% vs CM 35%). No significant differences between the two groups were reported in overall survivorship (RA 98.3% vs CM 97.3%), complication rate (RA 2.4% vs CM 1.4%) and operative time (RA 88 min vs CM 79 min). Despite higher costs, roboticassisted TKA offers better short-term clinical outcomes when compared to conventional manual technique with reduction in radiographic outliers and reduced risks of iatrogenic soft tissues injuries (reduced blood loss and postoperative drainage). Further high-quality long-term studies of modern robotic systems are required in order to evaluate how the increased accuracy and reduced outliers affect the long-term survivorship of the implants and the clinical outcomes.

The current state of robotics in total knee arthroplasty

“…The reported incidence of PJI in robotic TKA is low and based on a handful of cases in small comparative studies utilizing redundant systems. 19 , 71 Despite this, concerns have been raised regarding the potential increased risk posed by additional equipment, increased theatre traffic, surgical robotic techniques and increased operative time. 24 , 71 These factors have been suggested as likely contributors in a recent registry study highlighting increased early revision for infection in robotically assisted arthroplasty.…”

“…Two recent systematic reviews suggested that the incidence was higher in robotic TKA at 1.6–1.7% compared to 0.44–1.00% in manual TKA. 19 , 71 However, these data were based on a limited number of comparative studies using earlier active robotic technology that is now obsolete. 9 , 14 , 23 , 72 Given the small numbers involved, it is questionable whether these figures were a true representation of PJI for each treatment group.…”

“… 14 The surgeon then performs the initial surgical approach, positions retractors to protect soft tissues and attaches the limb to a fixed holding device. 19 Post final calibration, the robotic arm is initiated and performs the femoral and tibial bony resections independently. 20 Once activated, the surgeon maintains control via an emergency manual override button.…”

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…However, the application of this robotic system was limited because of increased operative time, insufficient versatility and technical complexity 21–23 . The objective of the robotic‐assisted TKA system is to provide a tool for surgeons to accurately resect bone and accurately select and balance implant and soft tissue placement 24–26 . To date, multiple robotic‐assisted TKA systems, such as Mako (Stryker), Navio PFS (Plymouth) and Robodoc (CurexoTechnology), have been clinically used 22,27,28 .…”

“…[21][22][23] The objective of the robotic-assisted TKA system is to provide a tool for surgeons to accurately resect bone and accurately select and balance implant and soft tissue placement. [24][25][26] To date, multiple robotic-assisted TKA systems, such as Mako (Stryker), Navio PFS (Plymouth) and Robodoc (CurexoTechnology), have been clinically used. 22,27,28 Until now, however, there have not been any robot-assisted TKA systems approved by the National Medical Products Administration of China.…”