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Robotics and Computer Navigation Do Not Offer Notable Benefits Compared with Manual Techniques for Total Knee
Alec Lachniet1, Sara E Strecker, Caitlin McCracken
1From the Bone and Joint Institute, Hartford Hospital, Hartford, CT (Mr. Lachniet, Dr. Strecker, Ms. McCracken, Dr. Shekhman, and Dr. Witmer), and theOrthopedic Associates of Hartford, Hartford, CT (Dr. Shekhman and Dr. Witmer).
Robotic-assisted total knee arthroplasty (TKA) significantly increased surgical costs without improving patient outcomes or complication rates compared to traditional methods. Computer navigation also showed no significant benefits. Surgeon comfort remains key for TKA success.
Area of Science:
- Orthopedic Surgery
- Medical Technology Evaluation
Background:
- Computer navigation and robotics are marketed for enhanced precision in total knee arthroplasty (TKA).
- These technologies aim to improve component positioning and soft-tissue balancing during TKA procedures.
Purpose of the Study:
- To compare the outcomes and costs of TKA performed with computer navigation, robotics, and manual instrumentation.
- To evaluate patient-reported outcome measures (PROMs) and complication rates across different TKA techniques.
Main Methods:
- A pragmatic, retrospective, single-center study of 4273 patients undergoing primary unilateral TKA for osteoarthritis.
- PROMs were collected preoperatively and up to 1 year post-surgery; statistical modeling assessed confounders.
Main Results:
- Robotic TKA use decreased, while computer navigation use increased; most TKAs (87%) used manual techniques.
- No significant differences in PROMs or complications were found among the techniques.
- Robotic TKA was associated with an average cost increase of $1500 compared to manual techniques.
Conclusions:
- Robotic assistance increased TKA costs without improving outcomes or complication rates compared to standard instrumentation.
- Computer navigation did not demonstrate significant advantages over manual TKA.
- The optimal TKA technique is dependent on surgeon proficiency and comfort.
