Robotic-assisted burr preparation significantly improves cement penetration but not immediate fixation strength in total knee arthroplasty.

Abstract

Although robotic-assisted total knee arthroplasty (TKA) is recognized for improving surgical precision, the effect of its bone preparation technique on cemented fixation remains unclear. This study compared the impact of robotic-assisted burr versus oscillating saw techniques on cement penetration and fixation strength. Seven paired (n = 14) fresh-frozen cadaveric specimens underwent either robotic-assisted TKA using a burr system or conventional TKA using an oscillating saw. Computer tomography scans quantified cement penetration, while maximum failure load was determined using pull-out testing. Cement penetration was significantly greater in the burr group compared to the saw group (3.79 ± 0.84 cm³ vs. 2.67 ± 0.99 cm³, p = 0.03). The average pull-out strength for the burr group has no statistical difference compared with the saw group (2939 ± 760.9 N vs. 2372 ± 760.5 N, p = 0.16). Bone preparation using a burr technique significantly improves cement penetration compared to conventional oscillating saw technique. However, this did not translate to improved immediate fixation strength in time-zero biomechanical testing. Further clinical studies are needed to determine if enhanced cement penetration provides long-term benefits for implant survivorship. N/A.