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. 2024 May 1;5(5):374-384.
doi: 10.1302/2633-1462.55.BJO-2024-0030.R1.

Robotic-assisted unicompartmental knee arthroplasty improves functional outcomes, complications, and revisions

Alessandro Bensa  1   2 , Alessandro Sangiorgio  1 , Luca Deabate  1 , Andrea Illuminati  3 , Benedetta Pompa  1 , Giuseppe Filardo  1   2
Affiliations

Robotic-assisted unicompartmental knee arthroplasty improves functional outcomes, complications, and revisions

Alessandro Bensa et al. Bone Jt Open. .

Abstract

Aims: Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions.

Methods: The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality.

Results: Among the 3,669 articles retrieved, 21 studies on 19 series of patients were included. A total of 3,074 patients (59.5% female and 40.5% male; mean age 65.2 years (SD 3.9); mean BMI 27.4 kg/m2 (SD 2.2)) were analyzed. R-UKA obtained a superior Knee Society Score improvement compared to C-UKA (mean difference (MD) 4.9; p < 0.001) and better Forgotten Joint Score postoperative values (MD 5.5; p = 0.032). The analysis of radiological outcomes did not find a statistically significant difference between the two approaches. R-UKA showed longer operating time (MD 15.6; p < 0.001), but reduced complication and revision rates compared to C-UKA (5.2% vs 10.1% and 4.1% vs 7.2%, respectively).

Conclusion: This meta-analysis showed that the robotic approach for UKA provided a significant improvement in functional outcomes compared to the conventional manual technique. R-UKA showed similar radiological results and longer operating time, but reduced complication and revision rates compared to C-UKA. Overall, R-UKA seems to provide relevant benefits over C-UKA in the management of patients undergoing UKA.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram.
Fig. 2
Fig. 2
Illustration of radiological outcomes: hip-knee-ankle angle (HKA; left), tibial slope (TS; centre), and tibial coronal alignment angle (TCA; right).
Fig. 3
Fig. 3
Correspondence between the 21 articles retrieved and the 19 series of patients analyzed.
Fig. 4
Fig. 4
a) Knee Society Score (KSS): forest plot of the individual studies and weighted mean difference (WMD) for KSS improvement, including a 95% confidence interval (CI). The size of the squares shows the weight of the study. Robotic-assisted unicompartmental knee arthroplasty (R-UKA) showed better KSS values compared to conventional UKA (C-UKA) (p < 0.001). b) KSS, medial UKA subgroup: forest plot of the individual studies and WMD for KSS improvement, including a 95% CI. The size of the squares shows the weight of the study. R-UKA showed better KSS values compared to C-UKA (p = 0.022). c) Forgotten Joint Score (FJS): forest plot of the individual studies and WMD for FJS values, including a 95% CI. The size of the squares shows the weight of the study. R-UKA showed better FJS values compared to C-UKA (p = 0.022).
Fig. 5
Fig. 5
a) Operating time: forest plot of the individual studies and pooled weighted mean difference (WMD) for operating time, including a 95% confidence interval (CI). The size of the squares shows the weight of the study. Robotic-assisted unicompartmental knee arthroplasty (R-UKA) showed longer operating time compared to conventional UKA (C-UKA) (p < 0.001). b) Operating time, medial UKA subgroup: forest plot of the individual studies and pooled WMD for operating time, including a 95% CI. The size of the squares shows the weight of the study. R-UKA showed longer operating time compared to C-UKA (p < 0.001).
Fig. 6
Fig. 6
Downs and Black’s tool for risk of bias assessment including the answers to the 27 ‘yes’ or ‘no’ questions for the each of the included studies. Green: yes. Red: no.
See this image and copyright information in PMC

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