Mid- to long-term outcomes of robotic arm-assisted total knee arthroplasty

Mid- to long-term outcomes of robotic arm-assisted total knee arthroplasty

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As the use of robotics in total knee arthroplasty (TKA) is increasing rapidly, noted to have increased sixfold over 6 years in the US alone [1], it is important to understand how the outcomes of robotic-assisted systems in TKA are faring in the medium term. In this part of the series, Sébastien Lustig from Lyon North University Hospital—Hospice Civils de Lyon, Lyon, France, reviews mid-term outcomes of robotic arm-assisted TKA, taking a closer look at patient-reported outcomes including patient satisfaction, and presents an emerging trend coming from recent registry data.

Sebastien Lustig

Sébastien Lustig

Lyon North University Hospital—Hospices Civils de Lyon, Lyon, France

Translating short-term results into mid-term outcomes

The number of TKAs continues to increase every year, with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) citing a 20.7% increase in TKA procedures in 2023 over 2022 [2]. Success of primary TKAs is often talked about in terms of prosthesis survival or time to revision, yet it is often long-term outcomes that are being considered. According to the AOANJRR [2], the cumulative percent revision of primary TKA for osteoarthritis at 20 year was 7.6% in 2024, with the most common reasons for revision being infection, loosening, instability, pain, and patellofemoral erosion. Although these relatively low long-term revision rates appear reassuring at first sight, such long-term data simply do not yet exist for robotic arm-assisted TKA due to their relatively recent introduction into clinical practice [3].

As seen in Part 2, immediate and short-term outcomes of robotic arm-assisted TKA are promising, indicating a rapid recovery with decreased inflammation, decreased pain and analgesia requirements, and shorter hospital stays [4, 5]. Further, patient-reported outcome measures (PROMs) have also been shown to have significantly improved indicating enhanced functional recovery [6–8]. Despite these promising short-term results, it is crucial to evaluate mid- to long-term outcomes, as this is when, according to Sébastien Lustig, potential complications associated with robotic arm assistance or alternative alignment techniques may emerge. Conversely, this longer period may also reveal improved implant survival compared to conventional techniques.

 

Excellent survivorship and low complication rates for image-based robotic arm-assisted total knee arthroplasty

Conventional TKA is known to have reliable results in terms of survivorship; in contrast, the few long-term results on robotic-assisted TKA mean that survival data is limited. Nevertheless, excellent survivorship and low complication rates are being reported in the mid to long-term [3, 9–11]. One study has reported 3-year outcomes of 210 robotic arm-assisted TKA with cementless cruciate-retaining implants in 182 patients [11]. At the 3-year follow-up, 100% survivorship of the implants was found with no reported cases of failure or loosening [11]. Low aseptic revision rates were also shown in Malkani et al [10], where, in their study on 188 robotic arm-assisted TKAs, two patients (1.06%) underwent revision, one for unexplained pain and one for a posttraumatic tibial fracture. Although in a study by Daffara et al [9] comparing cruciate-retaining or posterior stabilized implants in 164 robotic arm-assisted TKAs, survival per se was not reported, ...

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  • Translating short-term results into mid-term outcomes
  • Excellent survivorship, low complication rates
  • Promising functional outcomes
  • Operated joint awareness
  • Excellent patient satisfaction
  • Radiographic outcomes
  • Performs Robotic arm-assisted TKA better?
  • Conclusion
     
Personalized alignment philosophies
Part 1 | Personalized alignment philosophies
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Accuracy and early outcomes
Part 2 | Accuracy and early outcomes
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AO Recon resources

Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):
Fares Haddad

Fares Haddad

University College London and University College London Hospitals, London, UK

Michael Hirschmann

Michael T Hirschmann

Kantonsspital Baselland, Bruderholz, Switzerland

Sebastien Lustig

Sébastien Lustig

Lyon North University Hospital—Hospices Civils de Lyon, Lyon, France

This article was edited by Lyndsey Kostadinov, AO Innovation Translation Center, Clinical Science, Switzerland.

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