Precision analysis of robotic-assisted total knee arthroplasty. Experience from a high-volume center

Introduction

Total knee arthroplasty (TKA) is under constant revolution due to advanced technologies and the emergence of new surgical techniques. Advanced technologies like robotic-assisted TKA (RA-TKA) appear to show some advantages in terms of surgical precision when compared with conventional jig-based techniques (JB-TKA).

Methods

182 TKAs were studied retrospectively and divided in two groups, RA-TKA and JB-TKA (each n = 91). Postoperative Hb-drop (HBD) and red blood cell transfusion (RBCT) rates, pain score (VAS) at rest and on exercise, morphine milligram equivalent total consumption (MMETC), inpatient length of stay in days (LOS), surgery duration (SuDu) and hip–knee–ankle angle (HKA) and 90-day postoperative complications (90DC) were compared between two groups.

Results

No difference in HBD (2.2 g/dL in both groups p = 0.96), RBCT (0% in both), LOS (6.54 vs 6.78, p = 0.13), postoperative VAS at any point or 90DC (1 case in each group) could be detected between RA-TKA vs. JB-TKA. The RA-TKA SuDu was longer (83.65 vs 71.59 min, p < 0.001) but MMETC was lower (42.99 vs 58.46 mg, p = 0.08). RA-TKA had less outliers than JB-TKA (18 vs. 25, p = 0.22) and revealed a significantly lower deviation between planned and postoperative HKA (1.55 vs 2.16, p = 0.006).

Conclusion

While TKA could offer excellent patient recovery outcomes with low surgical morbidity equally in both groups, RA-TKA showed improved surgical precision and a tendency to less opioid consumption, which are deemed to be important preconditions for potentially improved outcomes over time. RA-TKA was also linked to a longer surgery time due to additional procedure-steps and learning curve.