Efficacy and safety of robotic-assisted knee reconstruction: a systematic review and meta-analysis

A.H. Alshahrani

Department of Orthopaedic Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia. ab.alshahrani@qu.edu.sa

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• Orthopedics

OBJECTIVE: Robotic-assisted surgery is increasingly being utilized in hip and knee reconstruction. However, the relative efficacy and safety of robotic-assisted total knee replacement (RATKR) compared to traditional surgery remained uncertain. This study aimed to systematically review the current literature comparing the outcomes of RATKR to traditional procedures.

MATERIALS AND METHODS: Comprehensive literature searches were conducted in major databases to identify studies comparing RATKR with traditional surgeries. The primary outcomes were functional scores and post-operative complications. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random effects model.

RESULTS: A total of 12 studies were considered for inclusion. The pooled functional scores of The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), hospital for Special Surgery (HSS) score, visual analogue score (VAS) pain score showed no significant differences between the two groups (MD = -0.99, 95% CI -2.32 to 0.34, p-value = 0.14). The subgroup analysis for hip and knee reconstructions also revealed no significant difference in terms of functional scores. However, for post-operative complications, while there was no significant difference in terms of blood loss (MD = -1.62, 95% CI -4.42 to 1.17, p-value = 0.25), the readmission rates were significantly higher in the RATKR group (MD = 0.94, 95% CI 0.77 to 1.11, p-value < 0.00001). The overall heterogeneity was extremely high (I² = 93%), particularly in the analyses of post-operative complications.

CONCLUSIONS: The findings suggested that robotic-assisted knee reconstruction did not significantly improve functional outcomes compared to traditional surgery. The safety profile was similar except for a higher readmission rate following RATKR. Given the high heterogeneity, further large-scale, well-designed, randomized controlled trials are needed to conclusively determine the efficacy and safety of robotic-assisted hip and knee reconstruction.

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