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A New Perspective on Manual Versus Technology-Assisted Total Knee Arthroplasty: Complications Stratified by Surgeon
Tyler T Brady1, Shaylan R Bera1, Benjamin R Paul2
1Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
Background:
Prior studies of technology-assisted total knee arthroplasty (TA-TKA) versus manual total knee arthroplasty (mTKA) have not accounted for surgeon subspecialty training, a possible modifier of outcomes. This study analyzed surgical complications following TA-TKA versus mTKA performed by fellowship-trained adult reconstruction surgeons versus other orthopaedic surgery subspecialties.
Methods:
Using a national database, patients who underwent primary TA-TKA who had a minimum of 5 years of records were identified using side-specific coding and propensity score matched 1:5 to mTKA controls based on demographics and comorbidities. The surgeon subspecialty was derived from standardized provider specialty codes and stratified into adult reconstruction and non-adult reconstruction cohorts (general, sports medicine, and trauma). Surgical complications were compared between TA-TKA and mTKA within and across subspecialty groups. Included were 15,407 TA-TKAs and 77,035 mTKAs.
Results:
At five years, TA-TKA performed by adult reconstruction surgeons was associated with significantly less aseptic loosening (odds ratio [OR]: 0.34, 95% confidence interval [CI]: 0.15 to 0.77) and manipulation under anesthesia OR: 0.64, 95% CI: 0.46 to 0.90) when compared to mTKA performed by all surgeons. When performed by non-adult reconstruction surgeons, TA-TKA was associated with higher rates of instability (OR: 1.22, 95% CI: 1.02 to 1.46) and all-cause reoperation (OR: 1.12 at two years, 95% CI: 1.01 to 1.24) compared with mTKA. Within the TA-TKA group, adult reconstruction surgeons achieved significantly lower rates of aseptic loosening (OR: 0.38, 95% CI: 0.01 to 0.87), instability (OR: 0.49, 95% CI: 0.25 to 0.97), manipulation under anesthesia (OR: 0.61, 95% CI: 0.43 to 0.86), and all-cause reoperation (OR: 0.71, 95% CI: 0.53 to 0.96) at five years compared with non-adult reconstruction surgeons.
Conclusions:
Surgeons cannot assume that performing TA-TKA will inherently yield superior outcomes compared to mTKA based on the current analysis. Future research should further investigate these findings to better elucidate TA-TKA utility.