Does Use of Technology Affect Manipulation Under Anesthesia Rates in Total Knee Arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Arthroplasty Research

Background:

• Arthrofibrosis following total knee arthroplasty (TKA) can lead to patient dissatisfaction.
• Manipulation under anesthesia (MUA) is a procedure to improve range of motion post-TKA.
• Computer-navigated and robotic-assisted technologies aim to enhance TKA precision and potentially reduce MUA rates.

Purpose of the Study:

• To investigate the impact of computer-navigated (N-TKA) and robotic-assisted (R-TKA) total knee arthroplasty on manipulation under anesthesia (MUA) rates compared to conventional TKA (C-TKA).
• To identify specific surgical factors associated with MUA in navigated and robotic-assisted TKA procedures.

Main Methods:

• A retrospective review of 18,815 primary, elective, unilateral TKAs performed between 2010 and 2022.
• Patients were categorized into conventional (C-TKA), computer-navigated (N-TKA), and robotic-assisted (R-TKA) groups.
• MUA rates were analyzed using ANOVA and multivariate logistic regression, considering fixation modes and implant constraints.

Main Results:

• The overall MUA rate was 1.7%, with R-TKA showing a higher rate (3.2%) than C-TKA (1.6%) and N-TKA (1.5%) in initial analysis (p<0.001).
• Multivariate analysis revealed no significant difference in MUA rates between N-TKA, R-TKA, and C-TKA when controlling for confounding factors.
• Cementless/hybrid fixation and cruciate-retaining (CR) designs, more common in R-TKA, were independently associated with increased MUA risk.

Conclusions:

• Navigated and robotic-assisted TKA demonstrate comparable MUA rates to conventional TKA after adjusting for confounding variables.
• Robotic-assisted TKA utilization of cementless/hybrid fixation and CR implants increases the likelihood of MUA.
• These operative factors are crucial for risk-stratification and patient counseling regarding MUA likelihood after TKA.