Robotic‐assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta‐analysis of randomized controlled trials

Abstract

Purpose Robotic-assisted total knee arthroplasty (R-TKA) has emerged as an alternative to improve the results of the conventional manual TKA (C-TKA). The aim of this study was to analyse the high-level studies comparing R-TKA and C-TKA in terms of clinical outcomes, radiological results, perioperative parameters, and complications. Methods The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 1 February 2023 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were: randomized controlled trials (RCTs), written in English language, published in the last 15 years, focusing on the comparison of C-TKA and R-TKA results. The quality of each article was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2). The statistical analysis was carried out using random efects (DerSimonian & Laird) for weighted mean diference (MD) of the continuous variables and Peto method for odds ratios of the dichotomous variables. Results Among the 2905 articles retrieved, 14 RCTs on 12 series of patients treated with mechanically aligned implants were included. A total of 2255 patients (25.1% males and 74.9% females; mean age 62.9 ± 3.0; mean BMI 28.1 ± 1.3) were analysed. The results of this systematic review and meta-analysis showed that R-TKA did not provide overall superior results compared to C-TKA in mechanically aligned implants in terms of clinical and radiological outcomes. R-TKA showed longer operative time (MD = 15.3 min, p = 0.004) and similar complication rates compared to C-TKA. A statistically signiicant difference in favour of R-TKA was found in the posterior-stabilized subgroup in terms of radiological outcomes (hip-knee-ankle angle MD = 1.7, p < 0.001) compared to C-TKA, although without resulting in appreciable diference of clinical outcomes. Conclusion R-TKA did not provide overall superior results compared to C-TKA in terms of clinical and radiological outcomes, showing longer operative time and similar complication rates. Level of evidence Level I.

Robotic-assisted unicompartmental knee arthroplasty improves functional outcomes, complications, and revisions

“…In fact, robotic assistance showed different results when used for TKA. In a recent systematic review and meta-analysis, Bensa et al 43 investigated the results of 14 randomized controlled trial (RCTs) for a total of 2,255 patients and found that R-TKA did not provide overall superior results compared to C-TKA in terms of clinical and radiological outcomes, while showing longer operating time, thus questioning the benefits of robotic-assisted surgery to improve TKA outcome in the routine clinical practice. An opposite scenario was found instead for UKA, where significant functional advantages of the robotic approach were found.…”

Robotic‐assisted total knee arthroplasty is not associated with improved accuracy in implant position and alignment compared to conventional instrumentation in the execution of a preoperative digital plan

“…A recent meta‐analysis reported that the robotic approach did not provide a relevant improvement compared to conventional manual TKA implanted in terms of clinical and radiological outcomes [ 4 ]. However, it needs to be highlighted that all the studies included in the metanalysis aimed at the mechanical alignment of TKA.…”

“…Mitchell et al found significant early clinical benefits with robotic TKA, including lower opioid requirements, and shorter length of stay, when compared with conventional TKA [ 22 ]. However, a recent meta‐analysis reported no relevant difference in the clinical results, therefore a clear superiority of RO‐TKA over CO‐TKA could not be demonstrated [ 4 ].…”

Robotic‐arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five‐year follow‐up

“…Therefore, pooling results from various studies using different robotic devices may mask any true differences in outcomes from this technology compared with conventional manual instrumentation for TKA. Bensa et al conducted a meta-analysis using 14 randomized controlled trials with 2,255 patients and reported no differences in clinical or radiological outcomes in mechanically aligned CO TKA versus RO TKA [8]. Recently, Glowalla et al reviewed radiological outcomes in 36 patients undergoing RO TKA and reported a statistically significant difference in residual deformity as measured with the intraoperative robotic system of 3.2° ± 1.9° and postoperative full leg radiographs of 1.4° ± 1.9°.…”