The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis
The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function, pain, quality of life and satisfaction with surgery.
PubMed, Medline, Embase and CENTRAL were searched. Included were comparative studies investigating the effectiveness of semi-active or active robotic hip or knee arthroplasty compared to any other surgical intervention on function, pain, quality of life and satisfaction with surgery. Risk of bias and the strength of the evidence were assessed using the Downs and Black tool and the GRADE system, respectively. Relative risks, mean differences and 95% CI were calculated using random-effects models.
Fourteen studies involving 1342 patients were included. All studies compared robotic to conventional surgery, with active robotic surgery evaluated in total hip or knee arthroplasty and semi-active robotic surgery in total hip or unicompartmental knee arthroplasty. Most studies presented some risk of bias, and the strength of evidence was rated as low to very low quality. Random-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short-, medium- and long-term follow-up. No significant difference in pain, quality of life and satisfaction with surgery were reported in individual studies.
This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery. Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain, quality of life and satisfaction with surgery is unclear.
PROSPERO Registration Number: CRD42017059932.
KeywordsRobotic surgery Hip Knee Arthroplasty Patient-reported outcomes
Compliance with ethical standards
Conflict of interest
Sascha Karunaratne, Michael Duan, Evangelos Pappas, Paul Stalley, Mark Horsley and Daniel Steffens declare that they have no conflict of interest.
Brett Fritsch owns stocks in Optimised Ortho and 360 Knee Systems; has performed consulting work for Optimised Ortho, 360 Knee Systems, Arthrex, Global Orthopaedics and Omni; and has received institutional support from Arthrex, Global Orthopaedics, Zimmer and Smith & Nephew.
Richard Boyle has performed consultancy work for Stryker, Adler, Signature and Global Orthopaedics and receives research assistance from Corin.
Sanjeev Gupta has performed consultancy work for Stryker, Depuy, Global Orthopaedics and Corin.
- 1.Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2017) Hip, knee & shoulder arthroplasty: 2017 annual report. https://aoanjrr.sahmri.com/documents/10180/397736/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty. Accessed 16 Apr 2018
- 2.Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster J (2004) Health-related quality of life in total hip and total knee arthroplasty: A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974. https://doi.org/10.2106/00004623-200405000-00012 CrossRefPubMedGoogle Scholar
- 4.van der List J, Chawla H, Joskowicz L, Pearle A (2016) Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: A systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(11):3482–3495. https://doi.org/10.1007/s00167-016-4305-9 CrossRefGoogle Scholar
- 6.Picard F, Moody J, DiGioia A, Jaramaz B (2004) Clinical classification of CAOS systems. In: DiGioia A, Jaramaz B, Picard F, Nolte L (eds) Computer and robotic assisted knee and hip surgery, vol 1. Oxford University Press, New York, pp 43–48Google Scholar
- 10.Porter I, Goncalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas J (2016) Framework and guidance for implementing patient-reported outcomes in clinical practice: Evidence, challenges and opportunities. J Comp Eff Res 5(5):507–519. https://doi.org/10.2217/cer-2015-0014 CrossRefPubMedGoogle Scholar
- 11.Atkins D, Eccles M, Flottorp S, Guyatt G, Henry D, Hill S, Liberati A, O'Connell D, Oxman A, Phillips B, Schunemann H, Edejer T, Vist G, Williams J, Grade Working Group (2004) Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches the GRADE working group. BMC Health Serv Res 4(1):38. https://doi.org/10.1186/1472-6963-4-38 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions. www.cochrane-handbook.org. Accessed 1 May 2017
- 14.Downs S, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384. https://doi.org/10.1136/jech.52.6.377 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Lingard E, Katz J, Wright R, Wright E, Sledge C, Kinemax Outcomes Group (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83-A(12):1856–1864. https://doi.org/10.2106/00004623-200112000-00014 CrossRefPubMedGoogle Scholar
- 18.Singh J, Schleck C, Harmsen W, Lewallen D (2013) Validation of the Hospital for Special Surgery knee questionnaire: convergent validity, responsiveness and sensitivity to change. Paper presented at the American College of Rheumatology Annual Meeting, San Diego, CA, October 25–30Google Scholar
- 22.Honl M, Dierk O, Gauck C, Carrero V, Lampe F, Dries S, Quante M, Schwieger K, Hille E, Morlock M (2003) Comparison of robotic-assisted and manual implantation of a primary total hip replacement: A prospective study. J Bone Joint Surg Am 85-A(8):1470–1478. https://doi.org/10.2106/00004623-200308000-00007 CrossRefPubMedGoogle Scholar
- 32.Liow M, Goh G, Wong M, Chin P, Tay D, Yeo S (2016) 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 Surg Sports Traumatol Arthrosc 25(9):22942–22951. https://doi.org/10.1007/s00167-016-4076-3 CrossRefGoogle Scholar
- 33.Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B (2006) Hands-on robotic unicompartmental knee replacement: A prospective, randomised controlled study of the Acrobot system. J Bone Joint Surg Br 88-B(2):188–197. https://doi.org/10.1302/0301-620X.88B2.17220 CrossRefGoogle Scholar
- 34.Coon T, Driscoll M, Horowitz S, Conditt M (2011) Robotically assisted UKA is more accurate than manually instrumented UKA. Int J Med Robot 7:50Google Scholar
- 35.Australian Government (2005) Impacts of advances in medical technology in Australia. Productivity Commission. https://www.pc.gov.au/inquiries/completed/medical-technology/report/medicaltechnology.pdf. Accessed 14 Nov 2017
- 36.American Joint Replacement Registry (2016) AJRR's patient-reported outcome measure guide. http://www.ajrr.net/images/downloads/Data_elements/AJRR_PROMS_GUIDE_2016_FINAL_4-5_FINAL.pdf. Accessed 14 Nov 2017
- 37.National Health Service (2017) Patient reported outcome measures (PROMs) in England: A guide to PROMs methodology. https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/patient-reported-outcome-measures-proms. Accessed 11 Feb 2018
- 38.International Consortium for Health Outcomes Measurement (2017) ICHOM: Hip & knee osteoarthritis data collection reference guide. vol 2.2.1. Massachusetts, USAGoogle Scholar
- 39.Rolfson O, Wissig S, van Maasakkers L, Stowell C, Ackerman I, Ayers D, Barber T, Benzakour T, Bozic K, Budhiparama N, Caillouette J, Conaghan P, Dahlberg L, Dunn J, Grady-Benson J, Ibrahim S, Lewis S, Malchau H, Manzary M, March L, Nassif N, Nelissen R, Smith N, Franklin P (2016) Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group. Arthritis Care Res 68(11):1631–1639. https://doi.org/10.1002/acr.22868 CrossRefGoogle Scholar