Robotic-assisted total knee arthroplasty reduced mid-term incidences of multiple orthopaedic complications: A large database study

Background: Robotic-assisted total knee arthroplasty (rTKA) provides surgeons the ability to make more accurate bone cuts and reduce outliers associated with conventional, jig-based total knee arthroplasty (cTKA). Despite its increase in popularity there continues to be insufficient data showing an improvement in mid-term patient outcomes. Materials and methods: The TriNetX Research Database was retrospectively queried for patients undergoing primary TKA with a follow up of at least 5 years after index surgery. Patient records with surgeries performed between January 1, 2012, to December 31, 2019. Records with comorbid indications other than primary TKA were excluded such as distal femur fractures, pathologic fractures, or revision arthroplasty. Propensity score matching at one-to-one ratio was performed to reduce confounding of preoperative risks. Outcomes of aseptic loosening, prosthetic joint infection, instability, periprosthetic fracture, and revision were queried at 1, 3, and 5 years. Results: In this study, 141,613 patients met all study eligibility requirements with 129,622 patients and 11,991 patients in the cTKA and rTKA cohorts, respectively. At 5 years, patients in the rTKA cohort had lower incidence of aseptic loosening (OR 0.335, 95% CI 0.224–0.501), prosthetic joint infection (OR 0.529, 95% CI 0.417–0.672), revisions (OR 0.758, 95% CI 0.609–0.943), and all complications combined (OR 0.640, 95% CI 0.550–0.745). Conclusions: Robotic TKA was found to be associated with a reduction in aseptic loosening, prosthetic joint infections, revisions, and all complications combined. This improvement in mid-term patient outcomes is observed at multiple time points out to 5 years, both before and after propensity score matching.