The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain

Abstract

The use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.

Robotic systems in total knee arthroplasty: current surgical trauma perspectives

“…As the authors of the commented article concluded, robot-assisted bone preparation and avoidance of unnecessary soft tissue release could decrease the surgical time that would otherwise be prolonged [ 1 ]. This conclusion partially echoes the literature reporting no difference in postoperative trauma, although increased registration time and length of incision could result in surgical trauma [ 28–30 ]. Although some short-term follow-ups have shown good clinical results for RA-TKA, the final conclusion regarding whether robotic surgery will decrease surgical trauma remains unknown [ 31 ].…”

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

“…A visual analog scale (VAS) was the most utilized tool for evaluating post‐operative pain, with 11 studies reporting differences between manual and technology assisted cohorts [3, 6, 10, 11, 13, 16, 29, 30, 47, 49, 61]. Pooled data from four studies found significantly lower (i.e.…”

“…After evaluation of the title and abstracts, 44 articles remained for full‐text evaluation. Application of our pre‐determined inclusion and exclusion criteria yielded a total of 31 articles for the final analysis [2, 3, 6–8, 10, 11, 13, 14, 16, 19, 24, 26–32, 34, 36–38, 40, 44, 46–49, 52, 54–56, 59–61]. No additional studies were identified following a stepwise evaluation of each article’s reference list.…”

“…With the rapidly increasing utilization of TKA, adult reconstruction surgeons continue to explore new and emerging technological approaches (i.e. robotic‐arm assistance and computer‐assisted navigation) to improve the efficiency and satisfaction of this procedure [5, 20, 33], especially given their potential to reduce operative times, decrease length of stay, improve implant placement, and increase long‐term patient satisfaction as well as implant survivorship [22, 35, 38, 45, 57, 61].…”

Comparison of Postoperative Pain and Function in Robotic Total Knee Arthroplasty and Conventional Total Knee Arthroplasty Amongst Patients at King Fahad Medical City in Riyadh, Saudi Arabia

“…Moreover, robotic TKA has become more prominent worldwide. However, even with the advanced precision that robotic TKA offers, some studies did not show it had superiority compared to conventional TKA [ 17 , 18 , 19 ]. One study reported that robotic TKA was longer and more expensive, with no difference in the rate of complications or length of hospital stay [ 19 ].…”