The current state of robotics in total knee arthroplasty

Abstract

Robotic total knee arthroplasty (TKA) has demonstrated improved component positioning and a reduction of alignment outliers with regard to pre-operative planning. Early robotic TKA technologies were mainly active systems associated with significant technical and surgical complications. Current robotic TKA systems are predominantly semi-active with additional haptic feedback which minimizes iatrogenic soft tissue injury compared to conventional arthroplasty and older systems. Semi-active systems demonstrate advantages in terms of early functional recovery and hospital discharge compared to conventional arthroplasty. Limitations with current robotic technology include high upfront costs, learning curves and lack of long-term outcomes. The short-term gains and greater technical reliability associated with current systems may justify the ongoing investment in robotic technology. Further long-term data are required to fully ascertain the cost-effectiveness of newer robotic systems. Cite this article: EFORT Open Rev 2021;6:270-279. DOI: 10.1302/2058-5241.6.200052

Image-Free Handheld Robot for Total Knee Arthroplasty Improves Early Functional Recovery Compared with Conventional Total Knee Arthroplasty

“…Thistechnique allows the surgeon to guidethe robotic arm to perform the bonypreparation, and thereforerequires constant input forthe procedure to be completed.Semi-active robotic systems enable surgeons tohavethe overall control for bone resection and implantpositioning. The image-freehandheld robotic sculpting system, Navio, was introduced in knee arthroplasties in 2017 [9]. This system does not require preoperative CT imaging, which is an advantageous point.…”

“…TheMako Robotic Arm Interactive Orthopaedic system (StrykerLtd, Kalamazoo, MI, USA) is an image-guidedsemi-active robotic system for RA-TKA. On the other hand, theNavioSurgical System (Smith & Nephew, Inc., Memphis, TN, USA) is an image-freehandheld robotic sculpting system introduced in knee arthroplasties in 2017 [9].…”

Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives

“…Robotic systems are associated with high costs including the base system, operational costs, disposables, and preoperative imaging with an estimated initial start-up cost of approximately US$ 800,000 and recurring cost of $ 1500 per patient to implement and carry out surgical procedures and with disposable costing approximately between $ 750 and $ 1300. 10,38 Moreover, when image-based systems are used, preoperative imaging costs start from $ 260 and the annual maintenance costs for most robotic systems are between $ 40,000 and $ 150,000 and additional costs are required for the proper training of the surgical team. 39 Moschetti et al 39 reported that the robotic UKA system can be considered cost-effective in a high-volume setting of 100 cases annually, being case volume the most important determinant to the cost-effectiveness of the robotic system at the $ 50,000 willingness-to-pay (WTP) threshold, the most commonly used threshold used in the literature.…”

Total Knee Arthroplasty Hospital Costs by Time-Driven Activity-Based Costing: Robotic vs Conventional

“…In the late 1980s, robotic systems began to be used in the operating room, with the first robotic-assisted TKA (roTKA) completed in 1988. Since then, the last decade has seen a surge in the number of roTKAs performed [ [2] , [3] , [4] ]. There are multiple factors contributing to the increase in popularity and utilization of roTKA including studies reporting improved accuracy in implant positioning and limb alignment, better short-term clinical outcomes, and increased patient-reported outcome measures (PROMs) with respect to the conventional manual technique [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”