Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation

Abstract

Background Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR. Methods A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation. Results Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events. Conclusions Compared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation. Trial registration Clinicaltrials.gov (NCT# 03737149).

Robotic Total Knee Arthroplasty: An Update

“…Compared with C-TKR, R-TKR resulted in less loss of ROM immediately after surgery and faster recovery of ROM within three months after operation. Cadmon et al [ 44 ] showed that active ROM was significantly greater than 5.1° and 2.9° at one- and three-month follow-up, respectively, in patients operated with R-TKA compared to C-TKA. With respect to preoperative ROM, the improvement was higher in patients with R-TKA compared to C-TKA: 6.9° at 1-month follow-up and 4.9° at 3-month follow-up.…”

“…At long-term follow-up, knee ROM is significantly improved in both robotic and conventional TKA compared to preoperative status, but no statistically significant differences have been reported [ 44 , 45 ]. Lee et al [ 46 ] reported on 855 knees (194 robotic group, 391 navigational group, and 270 conventional group) comparing clinical and radiological outcomes during a minimum follow-up period of 10 years.…”

“…Better ROM has been associated with patient satisfaction and improved knee function, which are early indicators of a successful procedure. As R-TKR is considered to improve ROM at short-term follow-up [ 44 , 65 ], it may be also associated with improved early patient satisfaction compared to C-TKR. However, well-conduced RCTs at longer follow-up (more than 10 years) fail to find any statistically significant differences in term of knee ROM, PROMs, and overall survivorship between R-TKA and C-TKA [ 8 , 66 ].…”