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Meta-Analysis
. 2022 May;104-B(5):541-548.
doi: 10.1302/0301-620X.104B5.BJJ-2021-1506.R1.

Robotic arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-analysis of the MAKO robotic system

Junren Zhang  1 , Nathan Ng  2 , Chloe E H Scott  2 , Mark J G Blyth  3 , Fares S Haddad  4 , Gavin J Macpherson  2 , James T Patton  2 , Nick D Clement  2
Affiliations
Meta-Analysis

Robotic arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-analysis of the MAKO robotic system

Junren Zhang et al. Bone Joint J. 2022 May.

Abstract

Aims: This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA).

Methods: Searches of PubMed, MEDLINE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta--Analysis statement. Search terms included "robotic", "unicompartmental", "knee", and "arthroplasty". Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis.

Results: A total of 179 articles were identified from initial screening, of which 14 articles satisfied the inclusion criteria and were included for analysis. The papers analyzed include one on learning curve, five on implant positioning, six on functional outcomes, five on complications, six on survivorship, and three on cost. The learning curve was six cases for operating time and zero for precision. There was consistent evidence of more precise implant positioning with MAKO RAUKA. Meta-analysis demonstrated lower overall complication rates associated with MAKO RAUKA (OR 2.18 (95% confidence interval (CI) 1.06 to 4.49); p = 0.040) but no difference in re-intervention, infection, Knee Society Score (KSS; mean difference 1.64 (95% CI -3.00 to 6.27); p = 0.490), or Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (mean difference -0.58 (95% CI -3.55 to 2.38); p = 0.700). MAKO RAUKA was shown to be a cost-effective procedure, but this was directly related to volume.

Conclusion: MAKO RAUKA was associated with improved precision of component positioning but was not associated with improved PROMs using the KSS and WOMAC scores. Future longer-term studies should report functional outcomes, potentially using scores with minimal ceiling effects and survival to assess whether the improved precision of MAKO RAUKA results in better outcomes. Cite this article: Bone Joint J 2022;104-B(5):541-548.

Keywords: Arthroplasty; Complications; Function; Knee; Knee Society Scores; Learning curve; MEDLINE; Outcome; Robotic; Robotic arm; Satisfaction; Unicompartmental knee; WOMAC scores; arthroplasty; functional outcomes; knee; medial unicompartmental knee arthroplasty; patient-reported outcome measures (PROMs); robotic arm-assisted unicompartmental knee arthroplasty.

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Figures

Fig. 1
Fig. 1
Complete Preferred Reporting Items for Systematic Review and Meta-­Analysis flow diagram showing the identification, screening, eligibility, and inclusion process.
Fig. 2
Fig. 2
Heat map of studies included in the systematic review and meta-analysis.
Fig. 3
Fig. 3
Forest plots of pooled precision in implant alignment, comparisons in a) femoral component coronal alignment error, b) femoral component sagittal alignment error, c) tibial component coronal alignment error, and d) tibial component sagittal alignment error. CI, confidence interval; IV, inverse variance; mUKA, manual medial unicompartmental knee arthroplasty; RAUKA, robotic arm-assisted unicompartmental knee arthroplasty; RMSE, root mean square error; SD, standard deviation.
Fig. 4
Fig. 4
Forest plot of pooled Knee Society Scores. CI, confidence interval; IV, inverse variance; mUKA, manual medial unicompartmental knee arthroplasty; RAUKA, robotic arm-assisted unicompartmental knee arthroplasty; SD, standard deviation.
Fig. 5
Fig. 5
Forest plot of pooled Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. CI, confidence interval; IV, inverse variance; mUKA, manual medial unicompartmental knee arthroplasty; RAUKA, robotic arm-assisted unicompartmental knee arthroplasty; RMSE, root mean square error; SD, standard deviation.
Fig. 6
Fig. 6
Forest plot of pooled reintervention and infection rates. CI, confidence interval; M-H, Mantel-Haenszel analysis; mUKA, manual medial unicompartmental knee arthroplasty; RAUKA, robotic arm-assisted unicompartmental knee arthroplasty; SD, standard deviation.
See this image and copyright information in PMC

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