Navigated and Robotic Total Knee Arthroplasty Do Not Confer Improved 5-Year Survivorship Compared to Conventional TKA: An Analysis from the American Joint Replacement Registry.

Introduction: Computer-assisted navigation (nTKA) and/or the use of robotics (rTKA) at the time of the primary total knee arthroplasty have been shown to improve implant position, minimize alignment outliers, and possibly improve patient outcomes compared to conventional instrumentation (cTKA). The purpose of this study was to use the linked Medicare dataset from the American Joint Replacement Registry (AJRR) to compare the mid-term (five-year) outcomes of nTKA and rTKA to those of cTKA.

Methods: All primary TKA procedures submitted to AJRR between January 2017 and December 2022 among patients aged 65 years and older were included in the analysis. The data were stratified into patients who underwent nTKA, rTKA, or cTKA at the time of their index procedure. The all-cause revision rate, mechanical loosening rate, and the other mechanical complication rate were determined at five years postoperatively. The survival model was adjusted for age, sex, fixation type, and year.

Results: At five years postoperatively, the survival model found computer navigation use to not be significant in TKA all-cause revision (P = 0.32) or mechanical loosening (P = 0.91) but was significant for other mechanical complications (P = 0.004). Robotic use was not found to be significant in TKA all-cause revision (P = 0.75), mechanical loosening (P = 0.42), or other mechanical complications (P = 0.46).

Conclusions: Navigation and/or the use of robotics at the time of primary total knee arthroplasty did not demonstrate a decrease in the need for revision at mid-term (5-year) follow-up among Medicare beneficiaries. While this study was unable to assess other important clinical outcomes following total knee arthroplasty with advanced technology, the purported benefits of utilizing this technology to improve component survival are not supported.