Patient Preferences for Tracker Pin-Related Incision Configurations in Robotic-Assisted Total Knee Arthroplasty

Robotic-assisted total knee arthroplasty (TKA) requires tracker pin placement, which may result in different incision configurations. Although clinical outcomes across pin placement strategies appear comparable, patient preferences regarding incision design remain unclear.

This cross-sectional observational study included 101 patients with knee osteoarthritis who were recruited consecutively at a tertiary university hospital. Three tracker pin-related incision configurations were presented using standardized lower-limb models: (A) all-inside, consisting of the longest single midline incision; (B) femoral pin in-tibial pin out, consisting of a medium-length midline incision plus two tibial stab incisions; and (C) pin outside, consisting of the shortest midline incision plus four stab incisions. Participants rated each design using a 5-point Likert scale and selected a single preferred option. Cosmetic and recovery concerns were assessed using five Likert-scale items.

Postoperative scarring received the highest concern ratings, followed by recovery time, whereas concern about incision length and the number of incisions was lower. Preference scores showed a numerical ranking: all-inside 4.0 [interquartile range (IQR), 3.0-4.0]; femoral pin in-tibial pin out 3.0 [IQR, 2.0-4.0]; and pin outside 3.0 [IQR, 2.0-3.0], without a statistically significant difference (Friedman χ² = 5.52, P = .063). When selecting a single preferred option, 46.5% chose all-inside, 25.7% femoral pin in-tibial pin out, and 27.7% pin outside.

No clear differences in overall preference were observed among the three incision configurations. Preoperative counseling should address expectations regarding scar appearance, wound care, and recovery trajectory rather than emphasizing incision configuration alone in robotic-assisted TKA.