Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes—A Single Surgeon Experience

Robotic arm-assisted total knee arthroplasty (RA-TKA) has been increasingly adopted in the adult reconstruction practices in the United States. A multitude of studies have evaluated clinical outcomes after RA-TKA.[1] [2] [3] [4] Notwithstanding, the evidence on this subject is constantly evolving.

Through the current investigation, the authors have assessed the impact of transition from the manual to RA-TKA on short-term clinical outcomes. Nevertheless, this study similar to many previous ones,[4] [5] lacks pertinent details, and this needs to be emphasized to ensure uniform, fair and directional evidence and allow reproducibility of this topic in future.

The introduction of RA-TKA with its associated impact on surgical accuracy, clinical outcomes, and even opioid use has been analyzed by multiple authors in the United States.[1] [2] [3] [4] However, it is hard to find even a single study which has elaborated in detail on the operative planning and technique, and the current study falls in the same heap. Small surgical decisions and intraoperative changes to the plan in RA-TKA might impact the eventual clinical outcomes in these patients, and if not clearly presented in the research literature, it might prove to be a hurdle for practicing surgeons to reproduce the published outcomes on paper in their clinical practice. This can potentially prove to be a big limitation and deficit among adult reconstructive surgeons; unfortunately, there is no easy way to measure the repercussions of this void.

According to our group, patient-specific goals set before RA-TKA, including the target leg alignment from the neutral (sagittal; valgus vs. varus), transepicondylar axis to posterior condylar axis offset (coronal), medial and lateral joint gaps in flexion and extension, joint line, etc., should be clearly delineated under the “Methods” section of all the journal submissions in this area. The symmetry of gaps should be defined in each investigation, as acceptable differences between medial and lateral gaps can be heterogenous among surgeons. The magnitude of bony cuts and their location (femur, tibia) should also be included. Furthermore, the authors should not only mention if posterior cruciate ligament is spared or resected in their RA-TKA cohort, but also if this is part of the initial plan or there are changes made to the surgical plan later on to avoid large bony cuts. Broadly, preoperative plan, surgical goals and technique (including all changes, if any), to reach those goals with respect to each landmark and variable, should be laid down systematically in the paper. In other words, there is a need of a detailed description of the technique which could be applicable to all the RA-TKA cases included in a published study. Surgeons who are still in their learning phase or those who have not even started performing RA-TKA do not just need to know that RA-TKA results in superior clinical outcomes as compared with the manual TKA, they also need to be exposed to all the intricacies of the surgical technique, which, if not clear, compromises learning process of novice surgeons and might actually result in substandard clinical outcomes. We recommend the readers to consider this developing loophole in RA-TKA literature, and request the authors to focus on the exact operative technique whenever they conduct a study on RA-TKA next time. This is the only way we can share knowledge, including surgical tricks among our orthopedic surgery community, and prevent any unintended disservice to patients.

Publication History

Received: 23 July 2021

Accepted: 11 August 2021

Article published online:
02 October 2021

• References

• 1 Zhang F, Li H, Ba Z, Bo C, Li K. Robotic arm-assisted vs conventional unicompartmental knee arthroplasty: a meta-analysis of the effects on clinical outcomes. Medicine (Baltimore) 2019; 98 (35) e16968
• 2 Smith AF, Eccles CJ, Bhimani SJ. et al. Improved patient satisfaction following robotic-assisted total knee arthroplasty. J Knee Surg 2021; 34 (07) 730-738
• 3 Ofa SA, Ross BJ, Flick TR, Patel AH, Sherman WF. Robotic total knee arthroplasty vs conventional total knee arthroplasty: a nationwide database study. Arthroplast Today 2020; 6 (04) 1001-1008.e3
• 4 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; 32 (11) 1063-1068
• 5 Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019; 8 (05) 327-336