Patient expectations and satisfaction in robotic-assisted total knee arthroplasty: a prospective two-year outcome study

Abstract

IntroductionThe impact of fulfillment of patient expectations throughout recovery on satisfaction in total knee arthroplasty (TKA) is not well understood. Utilizing a standardized TKA method with a robotically assisted (RA) platform, we investigated the impact of expectation fulfillment at 3-month (M) and 6-M on 1-year (Y) and 2-Y satisfaction. We hypothesize that early fulfillment of patient expectations is associated with improved midterm patient satisfaction. We also compare improvements in outcomes with RA-TKA to those of a recent large national TKA cohort study to determine whether RA-TKA meets or exceeds the current standard of care. Materials and methods One hundred six patients were prospectively enrolled and underwent robotic-assisted TKA by a single surgeon using the OMNIBotics system. Patients completed KOOS and New Knee Society Score (KSS) preoperatively and at 3M, 6M, 1Y, and 2Y postoperatively. Expectation fulfillment was subdivided into patients who were below or above the average expectation score pre-operatively, or fulfillment of expectation score at 3M and 6M post TKA. The satisfaction of each group was then compared at 1Y and 2Y post TKA. Study cohort outcomes were compared to contemporary literature from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) database. Results Patients with greater than average KSS expectation fulfillment at 3M reported significantly higher KSS satisfaction scores at 1Y (34.9 ± 5.3 vs 30.6 ± 6.7, p = 0.0012), and patients with greater than average 6M expectation fulfillment reported improved satisfaction at 1Y (33.9 ± 5.9 vs 31.1 ± 6.7, p = 0.0330) and 2Y (35.2 ± 4.8 vs 32.4 ± 6.8, p = 0.0323). When compared to the FORCE-TJR database, no significant differences in post-operative KOOS outcomes were observed except for Sports and Recreation, for which the RAS group demonstrated higher scores (65.5 ± 30.0 vs 53.0 ± 27.1 p < 0.0001); however, the study cohort reported significantly greater improvements in KOOS Pain, Symptoms, Sports and Recreation, and Quality of Life at multiple time points up to 2 years post TKA. Conclusion High early-expectation fulfillment was associated with improved satisfaction at 1Y and 2Y, indicating the importance of managing patient-specific post-operative care to ensure patients reach their pre-operative goals. Greater improvements in all KOOS sub-scores and in absolute Sports and Recreation at 1Y and 2Y were observed in this roboticassisted cohort compared to a large contemporary database, indicating that RAS meets or exceeds current standard of care benchmarks for patient-reported outcomes.

Use of intraoperative technology in total knee arthroplasty is not associated with reductions in postoperative pain

“…Despite no differences in post‐operative pain reported in the included studies, opioid consumption was reported to be higher in the manual cohort among most articles reporting longer follow‐up intervals [30, 38, 40]. One possible explanation behind this finding may related to patient and provider expectations regarding acute post‐operative analgesic needs [4]. For example, despite comparable post‐operative pain profiles, manual TKA patients may receive higher inpatient prescription MMEs compared to technology‐assisted cohorts [14].…”

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…Previous studies showed that robotic-assisted TKA can offer more accurate bone cuts, precise placement of implants and provide balanced extension and flexion gaps [ 29 , 30 ]. Moreover, robotic-assisted TKA can reduce the extent of bone resection and damage to the soft tissue, which are associated with postoperative pain [ 31 ]. However, the clinical application of these robotic systems was limited due to their technical complexity, insufficient versatility and increased operative time [ 31 ].…”

“…Moreover, robotic-assisted TKA can reduce the extent of bone resection and damage to the soft tissue, which are associated with postoperative pain [ 31 ]. However, the clinical application of these robotic systems was limited due to their technical complexity, insufficient versatility and increased operative time [ 31 ]. Until now, there are still no robotic-assisted TKA systems approved by the National Medical Products Administration of China.…”

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study

“…In contrast, a one- and two-year prospective study indicates that robotically assisted surgery results in improved outcomes in terms of patient well-being, and performance in sports and recreational activities, indicating that robotically assisted surgery meets or exceeds current reference standards of care for patient-reported outcomes [ 26 ].…”