Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis were conducted to compare the accuracy of component positioning, alignment and balancing techniques employed, patient-reported outcomes, and complications of robotic-arm assisted total knee arthroplasty (RATKA) with manual TKA (mTKA) and the associated learning curve. Searches of PubMed, Medline and Google Scholar were performed in October 2020 using PRISMA guidelines. Search terms included “robotic”, “knee” and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for RATKA and those comparing the component position accuracy, alignment and balancing techniques, functional outcomes, or complications with mTKA. There were 198 articles identified, following full text screening, 16 studies satisfied the inclusion criteria and reported the learning curve of rTKA (n=5), component positioning accuracy (n=6), alignment and balancing techniques (n=7), functional outcomes (n=7), or complications (n=5). Two studies reported the learning curve using CUSUM analysis to establish an inflexion point for proficiency which ranged from 7 to 11 cases and there was no learning curve for component positioning accuracy. The meta-analysis showed a significantly lower difference between planned component position and implanted component position, and the spread was narrower for RATKA compared with the mTKA group (Femur coronal: mean 1.31, 95% confidence interval (CI) 1.08–1.55, p<0.00001; Tibia coronal: mean 1.56, 95% CI 1.32–1.81, p<0.00001). Three studies reported using different alignment and balancing techniques between mTKA and RATKA, two studies used the same for both group and two studies did not state the methods used in their RATKA groups. RATKA resulted in better Knee Society Score Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation compared to mTKA in the short-to-mid-term follow up (95%CI [− 1.23, − 0.51], p=0.004). There was no difference in arthrofibrosis, superficial and deep infection, wound dehiscence, or overall complication rates. RATKA demonstrated improved accuracy of component positioning and patient-reported outcomes. The learning curve of RATKA for operating time was between 7 and 11 cases. Future well-powered studies on RATKAs should report on the knee alignment and balancing techniques utilised to enable better comparisons on which techniques maximise patient outcomes.Level of evidence III.

Imageless robotic-assisted revision arthroplasty from UKA to TKA

“…Furthermore, postoperative coronal alignment parameters were all comparable between the groups. In addition to the numerous published studies on improved alignment accuracy in primary robotic-assisted knee arthroplasty in comparison to conventional TKA [ 12 , 19 , 23 , 26 , 31 ], this case series was able to demonstrate a comparable accuracy and outcome to robotic-assisted primary knee arthroplasty. Intraoperative control of component alignment and joint line restoration in revision arthroplasty is often a challenge due to further bone loss or loss of bony reference points after implant removal.…”

“…Robotic-assisted primary TKA (RA-TKA) is increasingly gaining popularity in the orthopaedic domain [ 9 ]. The main advantages of RA-TKA include improved component alignment and real-time control of soft tissue balance [ 12 , 19 , 23 , 26 , 31 ]. The use of RA-TKA in the context of UKA revision is a promising approach to improve the results of these revision procedures.…”

Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making

“…Balanced gaps have been considered a prerequisite for good function and endurance in TKA, and a balanced knee could affect clinical outcomes [ 22 ]. Moreover, this precision and intraoperative feedback on the gap balancing could possibly minimize limitations in the conventional techniques and sizing options [ 23 ].…”

Advances in Surgical Techniques for Robotic Computer-Navigated Total and Unicompartmental Knee Arthroplasty

“…Hozack et al found that patients undergoing RATKA had significantly higher functional activity scores at 6 weeks and 1 year postoperatively [67]. A meta-analysis done by Zhang et al included seven clinical studies that reported functional outcomes when comparing RATKA using different robotic devices to conventional TKA [68]. Different outcome scores were utilized across the included studies, with the KSS being the most reported followed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.…”