Technology Review: CT Scan-Guided, 3-Dimensional, Robotic-Arm Assisted Lower Extremity Arthroplasty

Robotic-arm assisted lower extremity arthroplasty using computed tomography scan (CT)-based 3-dimensional (3D) modeling operative technologies has increasingly become mainstream over the past decade with over 550,000 procedures performed between first use in 2006 and November 2021. Studies have demonstrated multiple advantages with these technologies, such as decreased postoperative pain and subsequent decreased narcotic usage, decreased lengths of stay, less complications, reduced damage to soft tissues, decreased readmissions, as well as economic advantages in the form of meaningful cost savings for payors. The purpose of this report was to clearly and concisely summarize the good-to-high methodology peer-reviewed, published literature regarding CT scan-based, 3-dimensional robotically-assisted unicompartmental knee arthroplasty, total knee arthroplasty, and total hip arthroplasty stratified by: (1) prospective randomized studies; (2) database comparison studies; (3) national registry studies; (4) health utility studies; (5) comparison studies; and (6) basic science studies. A literature search was conducted and, after applying inclusion criteria, each study was graded based on the modified Coleman methodology score ("excellent" 85-100, "good" 70-84, "fair" 55-69, "poor" <54 points). A total of 63 of 63 good-to-excellent methodology score reports were positive for this technology, including 11 that demonstrated decreased pain and/or opioid use when compared to traditional arthroplasty techniques. The summary results of these high-quality, peer-reviewed published studies demonstrated multiple advantages of this CT scan-based robotic-arm assisted platform for lower extremity arthroplasty.