This statement was downgraded due to the varying treatments (robots used) between studies. One high quality study (Kim, 2020) evaluating robotic assisted total knee arthroplasty (TKA) with conventional technique found no clinical benefits to robotic surgery, but another higher quality study (Cho, 2019) demonstrates improved accuracy and fewer outliers with robotics.
However, numerous low-quality studies demonstrate improved outcomes with robotic assisted TKA. King (2020) favored MAKO robotic assisted TKA to conventional jig technique for MUA. Jeon (2019) favored ROBODOC to conventional technique for periprosthetic fracture at 9 years with decreased outliers. Shaw (2021) favors robotic technique for 90-day revisions. Kayani (2018) finds robotic assisted TKA had benefits over conventional technology in early post op VAS pain and improved early functional recovery and discharge. Bollars (2020) image free robot decreased outliers. Hamilton (2021) robotic group had earlier discharge and more likely to go home. King (2020) showed MAKO robotic assisted TKA lead to shorter length of stay and reduction in pain. However, average procedure time was nine minutes longer in this group. While Liow (2014, 2017) showed that ROBODOC lead to similar short term clinical outcomes, the robotic assisted group showed better restore joint line and mechanical axis. Two-year outcomes showed subtle improvements with robotic assisted TKA. Marchand (2021) showed MAKO robotic assisted TKA improved two-year functional scores and lower aseptic revision rates. Marchand (2017) showed MAKO robotic assisted TKA improved short term pain, physical function, and total satisfaction. In Mitchell’s (2021) retrospective review, robotics demonstrated significant early clinical benefits with reduced length of stay, opioids, and re-admission. Park (2007) showed that ROBODOC improved accuracy, despite the risk of higher complications with inexperienced practitioners. Song’s (2013) ROBODOC procedure reduced outliers and lead to better balancing. Yang (2017) showed that ROBODOC reduced outliers and radiolucency. Bendich (2021) showed lower re-admission rate with robotic assisted TKA.
Benefits/ Harms of Implementation
Robotic assisted surgery may require preoperative imagery exposing the patient to radiation and its potential harm.
Outcome Importance
Practitioners should carefully examine the presented evidence during decision making, especially in the presence of robotic assisted surgery’s growing popularity for TKA.
Cost Effectiveness / Resource Utilization
Robotic assisted surgery, although more expensive, may cut cost by improving pain, decreased LOS, and readmissions. Long term outcomes may reduce revision burden.
Feasibility
This recommendation faces no feasibility challenge.
Future Research
Recent studies of this new and constantly improving and evolving technology show improved early short-term outcomes and pain scores. Novel robotic technologies will need to conduct long term randomized controlled trials to demonstrate clinical advantage (i.e., safety and efficacy) over conventional surgical techniques.
- Bendich, I., Kapadia, M., Alpaugh, K., Diane, A., Vigdorchik, J., & Westrich, G. (2021). Trends of Utilization and 90-Day Complication Rates for Computer-Assisted Navigation and Robotic Assistance for Total Knee Arthroplasty in the United States From 2010 to 2018. Arthroplasty today, 11, 134-139.
- Bollars, P., Boeckxstaens, A., Mievis, J., Kalaai, S., Schotanus, M. G. M., Janssen, D. Preliminary experience with an image-free handheld robot for total knee arthroplasty: 77 cases compared with a matched control group. European Journal of Orthopaedic Surgery and Traumatology 2020; 4: 723-729
- Cho, K. J., Seon, J. K., Jang, W. Y., Park, C. G., Song, E. K. Robotic versus conventional primary total knee arthroplasty: clinical and radiological long-term results with a minimum follow-up of ten years. International Orthopaedics 2019; 6: 1345-1354
- Hamilton, D. A., Ononuju, U., Nowak, C., Chen, C., Darwiche, H. Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA. Arthroplasty Today 2021; 0: 57-62
- Kayani, B., Konan, S., Tahmassebi, J., Pietrzak, J. R. T., Haddad, F. S. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone & Joint Journal 2018; 7: 930-937
- Kim, Y. H., Yoon, S. H., Park, J. W. Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clinical Orthopaedics and Related Research 2020; 2: 266-275
- King, C. A., Jordan, M., Bradley, A. T., Wlodarski, C., Tauchen, A., Puri, L. Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes-A Single Surgeon Experience. The Journal of Knee Surgery 2020; 0: 16
- Liow, M. H. L., Goh, G. S., Wong, M. K., Chin, P. L., Tay, D. K., Yeo, S. J. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surgery, Sports Traumatology, Arthroscopy 2017; 9: 2942-2951
- Liow, M. H., Xia, Z., Wong, M. K., Tay, K. J., Yeo, S. J., Chin, P. L. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. Journal of Arthroplasty 2014; 12: 2373-7
- Marchand, K. B., Moody, R., Scholl, L. Y., Bhowmik-Stoker, M., Taylor, K. B., Mont, M. A., Marchand, R. C. Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up. The Journal of Knee Surgery 2021; 0: 29
- Marchand, R. C., Sodhi, N., Khlopas, A., Sultan, A. A., Harwin, S. F., Malkani, A. L., Mont, M. A. Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation. Journal of Knee Surgery 2017; 9: 849-853
- Mitchell, J., Wang, J., Bukowski, B., Greiner, J., Wolford, B., Oyer, M., Illgen, R. L., 2nd Relative Clinical Outcomes Comparing Manual and Robotic-Assisted Total Knee Arthroplasty at Minimum 1-Year Follow-up. HSS Journal 2021; 3: 267-273
- Park, S. E., Lee, C. T. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. Journal of Arthroplasty 2007; 7: 1054-9
- Shaw, J. H., Lindsay-Rivera, K. G., Buckley, P. J., Weir, R. M., Banka, T. R., Davis, J. J. Minimal Clinically Important Difference in Robotic-Assisted Total Knee Arthroplasty Versus Standard Manual Total Knee Arthroplasty. Journal of Arthroplasty 2021; 7: S233-S241
- Song, E. K., Seon, J. K., Yim, J. H., Netravali, N. A., Bargar, W. L. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clinical Orthopaedics & Related Research 2013; 1: 118-26
- Yang, H. Y., Seon, J. K., Shin, Y. J., Lim, H. A., Song, E. K. Robotic total knee arthroplasty with a cruciate-retaining implant: A 10-year follow-up study. CiOS Clinics in Orthopedic Surgery 2017; 2: 169-176