Cutting through infection risk: robotic-assisted vs. conventional total knee replacement surgery - a meta-analysis

Surgical site infections (SSI) following knee replacement pose significant challenges, often attributed to microorganism contamination during surgery. Robotic-assisted total knee replacement (RA-TKR) offers potential advantages but may also raise concerns regarding infection risk. This systematic review and meta-analysis aimed to evaluate infection rates following RA-TKR compared to Conventional Total knee replacement (C-TKR) within the first-year post-implantation.

A systematic search of major databases was conducted from 2005 to November 2023. Eligible studies reported primary C-TKR and RA-TKR interventions, documented SSI incidence, and had a follow-up period of at least 12 months. Data on deep, superficial, and pin-site infections were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Summary estimates were generated using a random-effects model.

Eight studies were included, comprising 758,453 knees (6724 RA-TKR, 751,729 C-TKR). The overall SSI rate was 1.57% in conventional TKR and 1.29% in RA-TKR. Deep infection rates were 0.96% and 0.66% in conventional and robotic procedures, respectively, with no significant variation between them (Odds Ratio [OR] 1.27 [95% Confidence Interval [CI], 0.93 to 1.73], I2 = 0%, P-value = 0.13). Superficial and pin-site infection rates were comparable between both procedures (0.61% vs. 0.62%) with no significant difference (OR 1.21 [95% CI, 0.86 to 1.70], I2 = 0%, P-value = 0.28).

This meta-analysis shows low SSI rates for both RA-TKR and C-TKR within the first year post-implantation. Both techniques are viable with low SSI incidence, and further research should investigate longer-term outcomes and different robotic systems to refine infection risk understanding in knee arthroplasty.