Objective:

To evaluate the impact of robotic-assisted total knee arthroplasty (TKA) on revision rates compared to conventional TKA.

Approach:

• Study Design: A Level III observational registry study using data from the Australian Orthopaedic Association National Joint Replacement Registry.
• Participants: 178 surgeons performing 85,075 total knee arthroplasties for osteoarthritis from September 1999 to December 2023.
• Grouping: Surgeons were categorized based on their 2-year cumulative percent revision rates before adopting robotic assistance.
• Outcomes: Primary outcome was all-cause cumulative percent revision; secondary outcomes included revisions for infection, implant loosening, and instability.
• Analysis: Comparative analyses were limited to procedures performed from 2016 onward, adjusted for various factors.

Key Findings:

• Robotic-assisted TKA did not reduce all-cause revision rates compared to conventional TKA.
• High-revision-rate surgeons had lower revision risk in the first 3 months but more than twice the hazard of revision after 9 months.
• Failure patterns were similar with and without robotic assistance.
• Revision rates for infection, implant loosening, and instability did not change after robotic adoption.

Interpretation:

Robotic-assisted TKA does not confer a revision benefit at the cohort level, with specific patterns observed among high-revision-rate surgeons.

Limitations:

• Potential selection bias in robotic assistance cases.
• Lack of data on surgeon training or learning curves.
• Inability to assess alignment strategy or case complexity.
• Follow-up limited to a mean of 2.4 years and maximum of 7 years.

Conclusion:

Robotic-assisted TKA does not show a clear benefit in revision rates.

Sources:

• JBJS Open Access