Sleep quality after total knee arthroplasty: a comparative analysis of robotic-assisted and conventional techniques

Total knee arthroplasty (TKA) significantly alleviates pain and improves functionality in patients with end-stage knee osteoarthritis. However, postoperative sleep disturbances remain a common issue affecting quality of life (QOL) and rehabilitation. This study aimed to compare postoperative sleep quality between robotic-assisted TKA (RATKA) and conventional TKA (CTKA). This observational study enrolled 200 consecutive patients undergoing primary unilateral TKA, divided equally into RATKA and CTKA cohorts. All surgeries were performed by a single surgeon using cemented TKA, either conventionally or with the MAKO® robotic system. Standardized pain management and rehabilitation protocols were followed in both cohorts. Preoperative and postoperative sleep quality were evaluated weekly for the first month and subsequently at 3 and 6 months post-operatively, utilizing the Pittsburgh Sleep Quality Index (PSQI). Pain scores were recorded using the Visual Analog Scale (VAS). Preoperative PSQI scores showed no significant differences between the RATKA (5.55 ± 2.05) and conventional TKA (5.70 ± 2.26) groups. Postoperative sleep disturbances peaked at 1 week post-surgery in both cohorts (RATKA: 12.42 ± 1.75, TKA: 12.59 ± 2.42), with gradual improvement observed over 6 months, although baseline sleep quality was not fully restored. Pain scores (VAS) were significantly lower in the RATKA cohort at all postoperative intervals (p < 0.001). No significant correlation was found between sleep quality and age, BMI, gender, or surgical approach. Both RATKA and conventional TKA resulted in similar patterns of postoperative sleep disturbances, peaking shortly after surgery and progressively improving over 6 months without fully returning to pre-operative levels. Despite significantly better pain control in the RATKA cohort, postoperative sleep quality did not differ significantly between the two surgical techniques. Future research should explore comprehensive perioperative management strategies to address the multifactorial nature of sleep disturbances post-TKA.