Robotics and Computer Navigation Do Not Offer Notable Benefits Compared with Manual Techniques for Total Knee Arthroplasty.

Abstract

Computer navigation and robotics have been introduced to total knee arthroplasty (TKA) to improve precision in component positioning and soft-tissue balancing. Both technologies have been heavily marketed to both surgeon and patients alike. This pragmatic, retrospective, single-center study compared outcomes for patients who underwent a primary unilateral TKA for osteoarthritis between January 2020 and December 2023. Surgical technique and implant selection were left to surgeon choice. All TKAs were performed using a medial parapatellar approach, with the majority being cemented. Overall, 4273 patients met eligibility criteria. Patient-reported outcome measures (PROMs) were collected using an electronic patient engagement platform preoperatively and up to 1 year. Linear and logistic regression modeling were used to assess potential confounders. The use of computer navigation increased over the time frame assessed, whereas the use of robotics decreased. The majority (87%) of patients underwent a TKA using manual techniques. Noncemented fixation predominated in computer navigation and robotics; demographics reflected a younger, healthier, male patient population. No difference was noted in PROMs or complications among techniques. Costs differed markedly, with the robotic group being an average of $1500 more expensive, even when controlling for confounders. Robotics, but not computer-navigation, increased overall costs of TKA surgery without differences noted in complication rates or PROMs compared with standard instrumentation. This study is notable in that it is pragmatic, and no surgeon involved had industry ties. The best technique for modern TKA remains the one an individual surgeon is most comfortable with.