A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design

Abstract

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined. Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems. In today’s paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine whether the initial capital is offset by improved outcomes. Future studies will have to determine the value of RA-TKA based on longer-term survivorships, patient-reported outcome measures, functional outcomes, and patient satisfaction measures. Cite this article: EFORT Open Rev 2021;6:252-269. DOI: 10.1302/2058-5241.6.200071

Comparison of manipulation rates for robot-assisted, customized, and conventional total knee arthroplasty: a retrospective cohort study

“…Firstly, no a priori sample size calculations were obtained. In a previous study, robot-assisted TKA decreased rates of MUA up to 4.5-fold compared with conventional TKA with at least 44 cases of MUA24; this study was unable to reproduce that finding because of an insufficient number of MUAs. Secondly, this was a retrospective analysis, which could allow for selection bias of patient characteristics associated with the choice of implants.…”

“…Firstly, no a priori sample size calculations were obtained. In a previous study, robotassisted TKA decreased rates of MUA up to 4.5-fold compared with conventional TKA with at least 44 cases of MUA 24 ; this study was unable to reproduce that finding because of an This study highlights the need for further research into the relationship between surgical technique and MUA. Future studies should be directed at having adequate sample sizes, incorporating data from multiple surgeons, and using novel surgical technologies.…”

Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives

“…48 Despite this was not believed to be clinically relevant until recently, it has now become apparent that component positioning has an important influence at least on short-term clinical outcomes. 49 Indeed, several studies have reported on short-term improved functional outcomes, soft-tissue protection, patient satisfaction, and less surgeon and surgical team fatigue when comparing rTKA with conventional technique. [50][51][52] However, further results to prove the effects on implant survivorship are still required.…”

Robotic Technology in Foot and Ankle Surgery: A Comprehensive Review

“…Despite advancements in implant designs and surgical techniques, CAS and robot technologies in TAA are underdeveloped compared to total hip and knee replacement [ 43 , 44 ]. CAS and robotic systems enable more precise bony resections and soft tissue balance and have been shown to improve implant position and alignment, lower risk for revision surgery, and improve functional outcomes [ 45 , 46 ].…”