Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background and purpose: Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better surgical accuracy. However, its impact on patient outcomes is uncertain. The aim of this systematic review of randomized controlled trials (RCTs) is to evaluate whether RATKA could improve functional and radiological outcomes compared with COTKA in adult patients with primary osteoarthritis of the knee.Methods: We searched Ovid MEDLINE, EMBASE, Scopus, and the Cochrane Library to identify published RCTs comparing RATKA with COTKA. 2 reviewers independently screened eligible studies, reviewed the full texts, assessed risk of bias using the Risk of Bias 2.0 tool, and extracted data. Outcomes were patient-reported outcomes, range of motion, and mechanical alignment (MA) deviation and outliers, and complications.Results: We included 12 RCTs involving 2,200 patients. RATKA probably results in little to no effect on patient-reported outcomes (mean difference (MD) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of –0.35 (95% confidence interval [CI] –0.78 to 0.07) and range of motion (MD –0.73°; CI –7.5° to 6.0°) compared with COTKA. However, RATKA likely results in a lower degree of MA outliers (risk ratio 0.43; CI 0.27 to 0.67) and less deviation from neutral MA (MD –0.94°; CI –1.1° to –0.73°). There were no differences in revision rate or major adverse effects associated with RATKA.Conclusion: Although RATKA likely results in higher radiologic accuracy than COTKA, this may not be clinically meaningful. Also, there is probably no clinically important difference in clinical outcomes between RATKA and COTKA, while it is as yet inconclusive regarding the revision and complication rates due to insufficient evidence.

High three‐dimensional accuracy of component placement and lower limb alignment using a robotic arm‐assisted system and gap‐balancing instrument in total knee arthroplasty

“…Respecting the patients' specific knee may help to increase clinical and functional outcomes. Potentially less revision surgery can be expected considering the fact that stiffness and instability as one of the main causes in up to 44% of these cases [15,20]. Robotic arm-assisted surgery helps to achieve the desired bone cuts and target limb alignment, along with symmetrically balanced flexion and extension gaps calculated intraoperatively [3].…”

Robotic-assisted total knee arthroplasty results in decreased incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty

“…But there are also many studies reporting that RATKA has higher accuracy of bone cuts and implant alignment. 11,12 Ruangsomboon et al 34 reported that although RATKA likely results in higher radiologic accuracy than manual TKA, there is probably no clinically important difference in clinical outcomes between RATKA and manual TKA. One of the reasons for the different conclusions is that the occurrence of surgical errors is becoming lower and low as the experience of the surgeon accumulates, and a relatively small sample size might affect the results, as a result, a larger sample study is needed.…”

Navigation und Robotik in der Totalendoprothetik des Kniegelenks – Evidenz?

“…In einem kürzlich veröffentlichten Review mit Metaanalyse lässt sich durchaus ein Vorteil für die Robotik im Vergleich zur manuellen Knieprothesenimplantation darstellen [38]. Eine andere aktuelle Metaanalyse findet allenfalls einen minimalen klinischen Vorteil in Bezug auf den WOMAC-Score und die postoperative Beweglichkeit [41]. Allerdings handelt es sich hierbei um wenige Studien, kleine Patientenzahlen und wenige untersuchte Parameter.…”