Trends and Outcomes in Technology-Assisted Total Knee Arthroplasty in the United States From 2020 to 2024

Technology-assisted total knee arthroplasty (TA-TKA), including computer navigation and robotic assistance, has been developed to improve implant alignment and soft tissue balance. While utilization has increased, evidence regarding clinical benefit remains mixed. This study evaluated national and regional utilization trends of TA-TKA and compared postoperative complication rates with manual TKA (M-TKA).

Patients undergoing primary TKA between January 1, 2020, and December 31, 2024, were identified in the TriNetX United States Collaborative Network. Patient demographics, hospital characteristics, and postoperative complications were obtained. Cohorts were 1:1 propensity score matched for sex, body mass index, and comorbidities. Surgical complications were compared at 0-30 days, 31-90 days, and 91 days-3 years between M-TKA and TA-TKA cohorts. In addition, subanalysis was conducted comparing 3-year surgical complication rates between TA-TKA and M-TKA, stratified by region.

Of 198,263 TKA patients, 147,156 underwent M-TKA and 39,624 underwent TA-TKA. TA-TKA utilization increased by 375%, from 11.9% in 2020 to 27.0% in 2024 (P < .0001). After matching, TA-TKA was associated with lower risks of periprosthetic fracture, deep infection, revision surgery, and aseptic loosening (all P ≤ .031). Across all regions, statistically significant findings demonstrated decreased risk of surgical complications at 3 years associated with TA-TKA when compared to M-TKA (P < .001).

TA-TKA utilization has more than doubled in recent years, though adoption remains variable across regions and institutions. Compared with M-TKA, TA-TKA was associated with significantly lower surgical complication rates through 3 years of follow-up. These findings support continued adoption of TA-TKA and highlight the need for further research on long-term outcomes and cost-effectiveness.