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Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Total knee arthroplasty (TKA) is a successful procedure in managing end-stage arthritis when non-operative treatments fail. New technologies such as robotic TKA (rTKA) have been developed to improve the accuracy of prosthesis implantation. While short-term cohort studies on rTKA have shown excellent results, the evidence comparing between rTKA and conventional TKA (cTKA) is not yet well established. This meta-analysis aims to compare the efficacy and safety of rTKA versus cTKA in terms of clinical outcomes, radiographic results, complications, peri-operative parameters and costs.

Methods

A multi-database search was performed according to PRISMA guidelines. Data from studies comparing between rTKA and cTKA were extracted and analyzed.

Results

Eighteen studies were included in this review, consisting of 2234 rTKA and 4300 cTKA. Robotic TKA led to a more precise prosthesis implantation with significantly fewer outliers in the mechanical axis (p < 0.001), femoral coronal (p = 0.002) and tibial sagittal (p = 0.01) alignments. Only the Hospital for Special Surgery (HSS) (p < 0.001) score at final follow-up was significantly better in rTKA than cTKA. rTKA also had a lower mean blood loss (p < 0.001) despite a longer mean operation time (p = 0.006). There were no statistically significant difference in terms of other clinical outcome measures, range of motion and complications.

Conclusion

Both rTKA and cTKA are reliable and safe to perform. However, rTKA is capable of achieving superior alignment in several axes, lower mean blood loss and this may lead to marginally better clinical outcomes than cTKA.

Evidence level

Level II, Meta-analysis of non-homogeneous studies

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia

    James Randolph Onggo, Jason Derry Onggo & Raphael Hau

  2. Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Jason Derry Onggo

  3. Department of Surgery Epworth Healthcare, University of Melbourne, University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia

    Richard De Steiger

  4. Epworth Eastern Hospital, 1 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia

    Raphael Hau

  5. Eastern Health Clinical School, Monash University, Box Hill, Melbourne, Vic, 3128, Australia

    Raphael Hau

  6. Northern Clinical School, University of Melbourne, Epping, Melbourne, Vic, 3076, Australia

    Raphael Hau

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  1. James Randolph Onggo
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Correspondence to James Randolph Onggo.

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Onggo, J.R., Onggo, J.D., De Steiger, R. et al. Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review. Arch Orthop Trauma Surg 140, 1533–1549 (2020). https://doi.org/10.1007/s00402-020-03512-5

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  • DOI: https://doi.org/10.1007/s00402-020-03512-5

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