Knee Surgery Complication Rates: Free-Hand vs. Computer-Assisted

Error-free, complication free knee arthroplasty is the objective, of course. Does computer assistance improve the rates of error-free and complication-free surgery? A new study from the Medical College of Wisconsin collected data on this subject and their work, “Revisiting Short-term Outcomes of Conventional and Computer-Assisted Total Knee Arthroplasty: A Population-based Study,” appears in the June 22, 2022, edition of the Journal of the AAOS:  Global Research and Reviews.

Co-author Abdalrahman Ahmed, B.S., a student at the Medical College of Wisconsin, provided a background to this research to OTW. “Prior to this study, the population-based studies in the literature providing insight on the advantages of computer-assisted total knee arthroplasty (TKA) over conventional total knee arthroplasty were outdated. Moreover, the more recent institution-based studies have relatively small sample sizes and thus may impede wide-scale adoption of this technology.”

“The aim of this study was to compare postoperative computer-assisted TKA and TKA in-hospital complications and 90-day all-cause readmissions using data from 2017-2018. To our knowledge this is the first study to analyze and provide insight on the complication rates of TKAs and computer-assisted TKAs in recent years. We hope this more recent insight on the postoperative outcomes of computer-assisted TKA will shift the paradigm toward greater acceptance of its benefits and drive wide-spread adoption.”

A retrospective study with data from the New York Statewide Planning and Research Cooperative System, this research included patients older than 45 years who had undergone a primary unilateral TKA or computer-assisted TKA.

As far as the definition of an in-hospital complication, the researchers used the 2020 Centers for Medicare & Medicaid Services risk-standardized total hip arthroplasty/TKA complications measure. The database used allowed for tracking of patient readmissions in New York State, thus readmissions within a 90-day period of discharge were able to be analyzed. During the study timeframe, 80,468 TKAs were performed in New York—7,395 (9.2%) of those were computer-assisted TKAs.

“Patients who had computer-assisted TKA had significantly fewer complications compared to patients that underwent conventional TKAs (0.4% of total computer-assisted TKAs vs 2.6% of total conventional TKAs, P < 0.001),” said Ahmed to OTW.

“Additionally, patients who had computer-assisted TKAs had fewer 90-day all-cause readmissions compared to those who underwent conventional TKAs (363 vs 4,169 revisits, P < 0.01). Although computer assistance was associated with significantly lower odds of in-hospital complications (odds ratio, 0.15, 95% confidence interval, 0.09 to 0.24; P < 0.05), 90-day all-cause readmissions were not found to be associated with lower odds.”

“In a prior study we showed that the majority of TKAs are still done conventionally. Our updated population-based findings that showed favorable outcomes for patients that underwent computer-assisted TKA should encourage wider adoption of the technology. Our findings may also help hospitals decrease their expenses under a bundled payment model.”