Robotic arm-assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In today's health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high-volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Student's t-tests. A p-value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short-term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short-term outcomes when compared with patients who undergo manual TKA.

The negative effects of obesity following total joint arthroplasty, such as increased morbidity and mortality, have been well documented in literature. However, little is known about whether specific body mass indices can be used as cutoffs to determine which patients are most at risk for having a poor postoperative outcome. We evaluated the effects of differing levels of obesity as measured by body mass index (BMI) on implant survivorship, Knee Society scores, complications, and radiographic outcomes. A systematic review of the literature was performed to identify all studies reporting outcomes of total knee arthroplasty in obese (30 ≤ BMI < 40 kg/m2) and morbidly obese patients (40 ≤ BMI < 50 kg/m2). Twenty-four studies were identified in our literature search. At a mean 5-year follow-up, morbidly obese patients (88%) had significantly lower implant survivorship than obese patients (95%) and nonobese patients (97%). Significantly, lower postoperative mean Knee Society objective and function scores (71 and 60 points) were observed for morbidly obese patients than for nonobese patients (75 and 90 points), but obese patients did not have significantly lower Knee Society objective and function scores than nonobese patients (78 and 84 points). Complication rates for nonobese, obese, and morbidly obese patients were 9, 15, and 22%, respectively, all of which were significantly different. However, no significant difference was observed in the incidence of radiolucent lines that were 12, 19, and 14%, respectively. Thus, we conclude that a BMI greater than 40 kg/m2 may be used as a cutoff to help guide patient education and treatment options for primary total knee arthroplasty.

Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.

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