Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials

Alessandro Bensa; Alessandro Sangiorgio; Luca Deabate; Andrea Illuminati; Benedetta Pompa; Giuseppe Filardo

doi:10.1007/s00167-023-07458-0

Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials

Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4680-4691. doi: 10.1007/s00167-023-07458-0. Epub 2023 Jun 3.

Authors

Alessandro Bensa¹, Alessandro Sangiorgio¹, Luca Deabate¹, Andrea Illuminati², Benedetta Pompa³, Giuseppe Filardo^{1

4}

Affiliations

¹ Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland.
² IRCCS Ospedale San Raffaele, 20132, Milano, Italy.
³ Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland. benedetta.pompa@gmail.com.
⁴ Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

PMID: 37270464
DOI: 10.1007/s00167-023-07458-0

Abstract

Purpose: Robotic-assisted total knee arthroplasty (R-TKA) has emerged as an alternative to improve the results of the conventional manual TKA (C-TKA). The aim of this study was to analyse the high-level studies comparing R-TKA and C-TKA in terms of clinical outcomes, radiological results, perioperative parameters, and complications.

Methods: The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 1 February 2023 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were: randomized controlled trials (RCTs), written in English language, published in the last 15 years, focusing on the comparison of C-TKA and R-TKA results. The quality of each article was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2). The statistical analysis was carried out using random effects (DerSimonian & Laird) for weighted mean difference (MD) of the continuous variables and Peto method for odds ratios of the dichotomous variables.

Results: Among the 2905 articles retrieved, 14 RCTs on 12 series of patients treated with mechanically aligned implants were included. A total of 2255 patients (25.1% males and 74.9% females; mean age 62.9 ± 3.0; mean BMI 28.1 ± 1.3) were analysed. The results of this systematic review and meta-analysis showed that R-TKA did not provide overall superior results compared to C-TKA in mechanically aligned implants in terms of clinical and radiological outcomes. R-TKA showed longer operative time (MD = 15.3 min, p = 0.004) and similar complication rates compared to C-TKA. A statistically significant difference in favour of R-TKA was found in the posterior-stabilized subgroup in terms of radiological outcomes (hip-knee-ankle angle MD = 1.7, p < 0.001) compared to C-TKA, although without resulting in appreciable difference of clinical outcomes.

Conclusion: R-TKA did not provide overall superior results compared to C-TKA in terms of clinical and radiological outcomes, showing longer operative time and similar complication rates.

Level of evidence: Level I.

Keywords: Alignment; Conventional; Knee; Mechanical alignment; Outcomes; Robotic; TKA; Total arthroplasty.

Publication types

Review