CORR Insights®: Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial.

Abstract

Inmy experience, a successful total knee replacement is determined by implant positioning, leg alignment, and soft-tissue balance, which includes medial-lateral and AP stability. My definition of a well-done TKA has not changed since the early 1980s, when our specialty—and patients’ lives— were improved by the development of precision mechanical alignment guides, and by the tireless work of David S. Hungerford MD who taught surgeons how to use them. The principles of successful rotational alignment of the implants, and soft-tissue treatment and balance were taught by Chitranjan S. Ranawat MD, and John N. Insall MD for posterior cruciate ligament sacrificing knees, andRichard D. ScottMD and Tom S. Thornhill MD for posteriorcruciate ligament retaining knees. These principles of total knee replacement have not appreciably changed through four decades, nor has implant design resulted in anything other than evolutionary change. The authors of the current study do not change the principles of the operation, but describe more-precise instrumentation, specifically for the bone cuts in the coronal plane [4]. Since the success of total knee replacement is dependent on rotational mating of the femoral and tibial implants, and the soft-tissue balance of the knee, both of which remain dependent on surgeon decisions no matter the instrumentation, it is unreasonable to expect a difference in clinical scores or revisions between a surgeon who performed 340 total knee replacements per year (as did the surgeon in this study) and the use of high-tech instruments. Indeed, no difference was found. But that does not mean that robotic instrumentation offers no value to low volume or inexperienced surgeons.