Robotic-assisted surgery and functional alignment in total knee arthroplasty: the RASKAL registry-nested 2 × 2...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Trials

Background:

• Robotic-assisted surgery and functional alignment are emerging techniques in total knee arthroplasty (TKA).
• Assessing their effectiveness compared to traditional computer-assisted surgery and mechanical alignment is crucial for clinical practice.
• Understanding the impact on patient outcomes and surgical efficiency is a key research area.

Purpose of the Study:

• To evaluate the individual and combined effectiveness of robotic-assisted surgery and functional alignment in TKA.
• To compare these newer techniques against computer-assisted surgery and mechanical alignment regarding clinical and functional outcomes.
• To analyze secondary outcomes including patient-reported measures, operative times, and adverse events.

Main Methods:

• A multicentre, blinded, 2x2 factorial randomized trial involving 303 TKA patients.
• Patients were randomized to either robotic-assisted or computer-assisted surgery, and functional or mechanical alignment.
• The primary outcome was the change in Knee Injury and Osteoarthritis Outcome Score (KOOS-12) over two years, with secondary PROMs and functional outcomes assessed.

Main Results:

• No significant differences were observed in KOOS-12 scores between robotic-assisted and computer-assisted surgery, or between functional and mechanical alignment at two years.
• Operative time was shorter with robotic-assisted surgery, and it showed better posterior cruciate ligament soft-tissue handling.
• Mechanical alignment was associated with a higher rate of soft-tissue release compared to functional alignment.

Conclusions:

• Robotic-assisted surgery and functional alignment did not demonstrate superiority over computer-assisted surgery and mechanical alignment in improving clinical and functional outcomes up to two years post-TKA.
• While robotic-assisted surgery offered benefits in operative time and soft-tissue management, these did not translate to improved patient-reported outcomes.
• Surgeons generally preferred the use of robotics and functional alignment, suggesting potential for future adoption despite current outcome equivalency.