Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty

Accuracy and Outcomes of a Novel Cut-Block Positioning Robotic-Arm Assisted System for Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background

The primary objective of this study was to determine the accuracy and precision of component positioning of the ROSA Robotic System for total knee arthroplasty (TKA).

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic review was conducted using 4 electronic databases (MEDLINE, EMBASE, Pubmed, and Cochrane Library) to identify all clinical and radiological studies reporting information about the use and results of the ROSA system. The criteria for inclusion were published research articles evaluating the accuracy of component positioning, learning curve, component alignment, complications, and functional outcomes in adults who underwent robotic-assisted TKA. The National Institutes of Health Quality Assessment Tool was used to evaluate the quality of all the included studies.

Results

A total of 26 studies were assessed for eligibility, and 17 met the inclusion criteria. Nine studies reported on the accuracy and precision of component positioning. The ROSA platform for TKA had a cutting error of less than 0.6° for all coronal and sagittal parameters. Pooled analysis demonstrated accuracy within 0.61-1.87° and precision within 0.97-1.34° when the final intraoperative plan was compared to postoperative radiographs with fewer outliers. Four studies reported improved functional scores with ROSA-assisted TKA than conventional TKA within 1 year of surgery. There was no difference in overall complication rates when compared to conventional TKA.

Conclusions

The ROSA system is both highly accurate and precise, with fewer outliers when analyzed at various time points, including postoperative standing radiographs. Future studies with robust methodology and longer follow-up are required to demonstrate whether these findings have any clinical benefits in the long term.

Interpreting the Current Literature on Outcomes of Robotic-Assisted Versus Conventional Total Knee Arthroplasty Using Fragility Analysis: A Systematic Review and Cross-Sectional Study of Randomized Controlled Trials

BACKGROUND

Fragility analysis is a method of further characterizing outcomes in terms of the stability of statistical findings. This study assesses the statistical fragility of recent randomized controlled trials (RCTs) evaluating robotic-assisted versus conventional total knee arthroplasty (RA-TKA versus C-TKA).

METHODS

We queried PubMed for RCTs comparing alignment, function, and outcomes between RA-TKA and C-TKA. Fragility index (FI) and reverse fragility index (RFI) (collectively, "FI") were calculated for dichotomous outcomes as the number of outcome reversals needed to change statistical significance. Fragility quotient (FQ) was calculated by dividing the FI by the sample size for that outcome event. Median FI and FQ were calculated for all outcomes collectively as well as for each individual outcome. Subanalyses were performed to assess FI and FQ based on outcome event type and statistical significance, as well as study loss to follow-up and year of publication.

RESULTS

The overall median FI was 3.0 (interquartile range, [IQR] 1.0 to 6.3) and the median reverse fragility index was 3.0 (IQR 2.0 to 4.0). The overall median FQ was 0.027 (IQR 0.012 to 0.050). Loss to follow-up was greater than FI for 23 of the 38 outcomes assessed.

CONCLUSIONS

A small number of alternative outcomes is often enough to reverse the statistical significance of findings in RCTs evaluating dichotomous outcomes in RA-TKA versus C-TKA. We recommend reporting FI and FQ alongside P values to improve the interpretability of RCT results.

Associations of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial

BACKGROUND

The association between postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) and nutrition status among elderly adults remained unclear. The authors aimed to evaluate these associations and provide a nutrition status reference for the surgical technique selection of TKA.

METHODS

In the present study, the authors used data from a multicenter, prospective, randomized controlled project, which recruited patients underwent TKA therapy. A total of 88 elderly adults (age ≥65 years old) were included in this study. Their preoperative and postoperative demographic data and radiographic parameters were collected. Clinical outcomes, including postoperative hip-knee-ankle (HKA) angle deviation, knee society score (KSS), 10 cm visual analog scale, and so on, were observed and compared between the RA-TKA group and the conventional TKA group. Logistic regression was performed to adjust several covariates. In addition, according to the results of restricted cubic splines analyses, all participants were categorized into two groups with GNRI≤100 and GNRI >100 for further subgroup analyses.

RESULTS

Our results showed despite having a lower postoperative HKA angle deviation, the RA-TKA group had a similar postoperative KSS score compared with the conventional TKA group in elderly adults. Among elderly patients with GNRI>100, RA-TKA group achieved significantly more accurate alignment (HKA deviation, P =0.039), but did not obtain more advanced postoperative KSS scores because of the compensatory effect of good nutrition status. However, among elderly patients with GNRI≤100, RA-TKA group had significantly higher postoperative KSS scores compared to the conventional TKA group ( P =0.025) and this association were not altered after adjustment for other covariates.

CONCLUSION

Considering the clinical outcomes of conventional TKA may be more susceptible to the impact of nutrition status, elderly patients with GNRI≤100 seem to be an applicable population for RA-TKA, which is more stable and would gain significantly more clinical benefits compared with conventional TKA.

A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience

BACKGROUND

Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years.

METHODS

A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated.

RESULTS

Preoperative mean Oxford score of the right knee of the patients was 18.5 ± 3.2, post-surgery mean Oxford score progressed to 43.5 ± 2.2. While the preoperative left knee Oxford score of the patients was 16.9 ± 2.3, the mean left knee Oxford score improved to 43.4 ± 2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ± 3.5, and progressed to 89.2 ± 4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ± 4.3, the mean KSS score improved to 89.8 ± 3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ± 3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ± 5.9.

CONCLUSION

The results of ROSA-supported knee arthroplasty found to be functionally successful.