Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System

Area of Science:

• Orthopedic Surgery
• Robotics in Medicine
• Arthroplasty

Background:

• Robotic-assisted total knee arthroplasty (rTKA) is gaining traction, yet literature on its use in revision procedures is limited.
• Recent FDA approval of imageless robotic systems highlights advancements in the field.
• This study addresses the need for data on robotic assistance in revision total knee arthroplasty (TKA).

Purpose of the Study:

• To describe the imageless surgical technique for robotic revision TKA using a second-generation robotic system.
• To detail intraoperative and 90-day outcomes of robotic-assisted revision TKA.
• To evaluate the feasibility and early results of imageless robotic surgery in revision TKA.

Main Methods:

• Retrospective review of 115 robotic revision TKAs performed between March 2021 and May 2023 across three academic centers.
• Collection of patient demographics, perioperative data, and 90-day outcomes, including pain and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
• Analysis of all-cause reoperations at final follow-up.

Main Results:

• Instability (32%) and aseptic loosening (37%) were the primary indications for revision TKA.
• Most revisions utilized a posterior-stabilized liner (83%), with 93% achieving joint line restoration within 5mm of the native knee.
• Low rates of adverse events were observed within 90 days (2 readmissions) and at final follow-up (5 reoperations).

Conclusions:

• Imageless robotic surgery demonstrates favorable intraoperative and 90-day outcomes in revision TKA.
• The technique appears to be a promising approach for revision total knee arthroplasty.
• Further comparative studies on longitudinal outcomes between robotic and conventional rTKA are warranted.