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Technology-Assisted Total Knee Arthroplasty Is Associated With Faster Initial Recovery, but Similar 1-Year Outcomes:
Kareem Omran1, Colleen Wixted2, Daniel Waren2
1Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Background:
Robotic- and navigation-assisted (RA and NA) total knee arthroplasty (TKA) systems aim to optimize surgical performance; however, their influence on the speed of functional recovery remains unclear. This study compared the time to achieve a Minimal Clinically Important Difference (MCID) among patients undergoing RA, NA, and conventional TKA using Knee injury and Osteoarthritis Outcome Score for Joint Replacement questionnaires.
Methods:
This retrospective cohort study included patients undergoing primary TKA for osteoarthritis at a tertiary academic center from July 2017 to July 2024. Inclusion required preoperative and postoperative Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores within 12 months of surgery. Exclusion criteria were nonosteoarthritis indications, bilateral procedures, or revision within one year. The MCID was defined using both anchor-based and distribution-based methods. The time to MCID was analyzed using multivariable interval-censored accelerated failure time models, accounting for clinical and demographic variables and the operating surgeon. A total of 2,002 patients met the inclusion criteria: 433 (21.6%) underwent RA-TKA, 713 (35.6%) NA-TKA, and 856 (42.8%) conventional TKA.
Results:
Both technology-assisted approaches were associated with faster MCID achievement compared to conventional TKA. Using distribution-based thresholds, NA-TKA achieved MCID 29% faster (time ratio [TR] = 0.71, 95% confidence interval (CI): 0.58 to 0.88, P = 0.002) and RA-TKA 26% faster (TR = 0.74, 95% CI: 0.57 to 0.95, P = 0.018), with covariate-standardized estimated median times of 19.9, 20.7, and 28.0 days, respectively. Using anchor-based thresholds, NA-TKA achieved MCID 27% faster (TR = 0.73, 95% CI: 0.57 to 0.95, P = 0.017) and RA-TKA 26% faster (TR = 0.74, 95% CI: 0.55 to 1.00, P = 0.050), with corresponding median times of 52.8, 53.5, and 71.9 days. The one-year MCID attainment rates were similar across all techniques (P > 0.6 for both definitions).
Conclusions:
Both RA-TKA and NA-TKA were associated with 26 to 29% faster achievement of clinically meaningful improvement compared with conventional TKA, corresponding to approximately seven to 19 fewer days to reach MCID, despite similar one-year attainment rates. Prospective multicenter studies are needed to validate these results and determine whether accelerated recovery translates to advantages in quality of life, health care utilization, and patient satisfaction.
