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NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA.

Methods

This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann–Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test.

Results

There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend.

Conclusions

This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA.

Level of evidence

Level III (therapeutic retrospective cohort study).

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Data availability statement

The data that support the findings of this study are available from the corresponding author JV, upon reasonable request.

Abbreviations

AE:

Adverse events

ACL:

Anterior cruciate ligament

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CRPS:

Complex regional pain syndrome

CTKA:

Conventional TKA

DAIR:

Debridement, antibiotics, irrigation, retention

ITB:

Iliotibial band

LOS:

Length of stay

MCL:

Medial collateral ligament

MUA:

Manipulation under anesthesia

N:

No

OR:

Operating room

ORIF:

Open reduction interal fixation

OT:

OR time

PAD:

Peripheral artery disease

PJI:

Periprosthetic joint infection

RATKA:

Robotic-assisted TKA

ST:

Surgical time

TKA:

Total knee arthroplasty

Y:

Yes

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Authors and Affiliations

  1. Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium

    Jim Vandenberk & Hilde Vandenneucker

  2. Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Jim Vandenberk & Hilde Vandenneucker

  3. St. Elisabeth Krankenhaus Geilenkirchen, Geilenkirchen, Duitsland

    Jorien Deferm

  4. Orthoteam Limburg, Dienst Orthopedische Heelkunde St. Trudo, Sint-Truiden, Belgium

    Jan Mievis & Daniël Janssen

  5. Orthopedie Sint. Trudo, Sint-Truiden, Belgium

    Peter Bollars

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Contributions

JM, PB, JV and JD designed the study. JV and JD performed the retrospective data collection. JV drafted the manuscript and designed the figures in consultation primarily with HV, with contributions by JM and DJ. All authors discussed the results and commented on the manuscript for final revision and have given approval for the work to be published.

Corresponding author

Correspondence to Jim Vandenberk.

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Conflict of interest

Hilde Vandenneucker: Institutional support: Aqtor chair of no influence on publication–Institutional support up to 2021: S&N chair/no Institutional support anymore at timing paper preparation and submission. S&N scientific grant, not used for this manuscript. Peter Bollars: aid consultant S&N (robotics and knee arthroplasty). The other authors declare that they have no competing interests.

Ethical approval

Ethical approval was obtained by the Independent Local Medical Ethical Review Board (Nr. STZH/2021/337).

Informed consent

Informed consent was not sought for this retrospective study as per guidelines of the Independent Local Medical Ethical Review board.

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Vandenberk, J., Mievis, J., Deferm, J. et al. NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 31, 4798–4808 (2023). https://doi.org/10.1007/s00167-023-07524-7

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