Robotic-Assisted Total Knee Arthroplasty in the Presence of Extra-Articular Deformity: Reducing Complexity and Cost

This study aimed to determine whether robotic-assisted total knee arthroplasty (TKA) represents a viable and cost-effective strategy for managing complex knees in the setting of extra-articular deformity.

We reviewed a consecutive series of 12 robotic-assisted TKAs performed in patients with a spectrum of femoral and tibial deformities, including retained hardware and posttraumatic malalignment. All procedures were completed as single-stage primary arthroplasties using the MAKO robotic platform. Patients were followed for 2 years postoperatively with radiographic evaluation and validated functional outcome measures. Cost-effectiveness analysis was performed in seven selected cases, comparing the actual cost of the robotic single-stage procedure with the projected cost of a two-stage conventional pathway.

All 12 patients underwent successful arthroplasty without the need for revision at the latest follow-up. Radiographically, a mean mechanical axis correction of 8.7 degrees was achieved. Significant improvements in functional scores and quality-of-life measures were observed at 2 years. In the seven cases evaluated for cost-effectiveness analysis, the robotic approach demonstrated net cost savings when compared with a staged conventional strategy.

Robotic-assisted TKA enables precise deformity management through enhanced preoperative planning and intraoperative guidance, allowing complex cases to be addressed in a single stage with favorable functional and economic outcomes.

Level of Evidence was IV.