Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis

Abstract

Background: In the field of prosthetics, the ultimate goal is to improve the clinical outcome by using a technique that prolongs the longevity of prosthesis. Active robotic-assisted total knee arthroplasty (TKA) is one such technique that is capable of providing accurate implant position and restoring mechanical alignment. Although relevant studies have been carried out, the differences in the efficacy and reliability between active robotic-assisted TKA and conventional arthroplasty have not yet been adequately discussed.

Methods: We referenced articles, including randomised controlled trials and comparative retrospective research, from PubMed, Embase, Cochrane Library and Web of Science, in order to compare active robotic-assisted TKA with the conventional technique. Data extraction and quality assessment were conducted for each study. Statistical analysis was performed using Revman V. 5.3.

Results: Seven studies with a total of 517 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (mean difference, MD: - 0.82, 95% CI: -1.15 to - 0.49, p < 0.05) and implant position, with lower outliers (p < 0.05), better functional score (Western Ontario and McMaster University, Knee Society Score functional score) and less drainage (MD: - 293.28, 95% CI: - 417.77 to - 168.79, p < 0.05). No significant differences were observed when comparing the operation time, range of motion and complication rates.

Conclusion: The current research demonstrates that active robotic-assisted TKA surgeries are more capable of improving mechanical alignment and prosthesis implantation when compared with conventional surgery. Further studies are required to investigate the potential benefits and long-term clinical outcomes of active robotic-assisted TKA.

Keywords: active robotic-assisted; conventional; meta-analysis; systematic review; total knee arthroplasty.

Figure 1

The flow chart of literature screening.

Figure 2

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

Figure 3

Mechanical alignment of RA versus CA. Mean difference below 0 indicates lower hip–knee–ankle angle of RA group than CA. RA, robotic-assisted arthroplasty; CA, conventional arthroplasty.

Figure 4

Mechanical alignment outlier rate of RA versus CA. OR under 0 indicates lower rate in RA group. RA, robotic-assisted arthroplasty; CA, conventional arthroplasty.

Figure 5

Assessment of femoral and tibial component alignment (referring to knee Society roentgenographic evaluation System33).

Figure 6

Range of motion of RA vs Ca. Mean difference indicates similar outcome. RA, robotic-assisted arthroplasty; CA, conventional arthroplasty; MD, mean difference.