According to new research from NYU Langone, employing computer-navigated and/or robotic-assist in surgery resulted in better alignment and personalization of implant positioning as well as shorter length of hospital stays. Patient reported outcomes, however, were comparable between conventional and navigation or robotic assisted surgery.
Robotic and Navigation TKA vs Conventional TKA: New Study
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These conclusions came after a retrospective review of 16,009 patients who underwent primary unilateral total knee arthroplasty (TKA) from January 2017 to October 2023. Their results were presented at the 2024 annual meeting of the American Academy of Orthopaedic Surgeons in San Francisco.
The researchers stratified patients into conventional (9,204; 57.5%), computer-navigated (4,309; 26.9%) and robotic-assisted TKAs (2,496; 15.6%). They found that the robotic (35.1) and navigated (46.9) cohorts had significantly shorter length of stay compared to the conventional group (53.9 hours). Both robotic (96.8%) and navigated (92.1%) groups showed higher rates of discharge to home compared to conventional (87.6%).
Robotic and navigated groups showed higher odds of achieving perfect activity measure for post-acute care scores on postop day 0 compared to conventional on multivariate regression. All three groups showed comparable patient-reported outcomes and 90-day readmission and revision rates.
“I think we can now see the use of technology benefits patients, at least in the short-term recovery,” co-author Morteza Meftah, M.D., associate professor of orthopedic surgery in the Division of Adult Reconstruction at NYU Langone Orthopedics, told OTW. “I think we have better target for alignment and personalized implant positioning, which has improved out outcomes after TKA.”
“It was striking to see improved AMPAC [activity measure for post-acute care] scores in TKA cases that technology was utilized, especially robotic cases. We also noticed that length of stay was much less in robotic group and most of them were able to be discharged home same day, which was statistically significant.”
“Hopefully,” said Dr. Meftah to OTW, “longer term follow up can show the benefits of using precision tools such as robotic platforms and we can further enhance the recovery and longevity of total knee arthroplasty.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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