JOA - 2026-05-13 - Journal Article
Technology-Assisted Total Knee Arthroplasty Is Associated with Faster Initial Recovery, But Similar One-Year Outcomes: A Retrospective Cohort Study of Patient-Reported Outcomes in 2,002 Patients.
Omran K, Wixted C, Waren D, Rozell JC, Schwarzkopf R
Topics
Key Takeaway
Navigation- and robotic-assisted TKA achieved MCID on KOOS-JR 26–29% faster than conventional TKA (median 20–21 vs. 28 days by distribution-based threshold), with no difference in 1-year MCID attainment rates.
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Summary
This study asked whether technology-assisted TKA (robotic or navigation) accelerates early functional recovery versus conventional TKA, using time-to-MCID on KOOS-JR as the primary endpoint in 2,002 primary TKA patients at a single academic center. Multivariable interval-censored accelerated failure time models showed NA-TKA and RA-TKA reached MCID 29% and 26% faster, respectively, translating to roughly 7–19 fewer days depending on MCID definition. One-year MCID attainment rates were equivalent across all three groups (P>0.6).
Key Limitation
Non-randomized technology assignment at a single academic center means unmeasured confounding by surgeon experience, case selection, and institutional learning curves cannot be excluded.
Original Abstract
BACKGROUND
Robotic and navigation-assisted total knee arthroplasty (TKA) systems aim to optimize surgical performance; however, their influence on the speed of functional recovery remains unclear. This study compared the time to achieve a minimal clinically important difference (MCID) among patients undergoing robotic-assisted (RA), navigation-assisted (NA), and conventional TKA using Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) questionnaires.
METHODS
This retrospective cohort study included patients undergoing primary TKA for osteoarthritis at a tertiary academic center from July 2017 to July 2024. Inclusion required preoperative and postoperative KOOS-JR scores within 12 months of surgery. Exclusion criteria were non-osteoarthritis indications, bilateral procedures, or revision within one year. The MCID was defined using both anchor-based and distribution-based methods. The time to MCID was analyzed using multivariable interval-censored accelerated failure time models, accounting for clinical and demographic variables and the operating surgeon. A total of 2,002 patients met the inclusion criteria: 433 (21.6%) underwent RA-TKA, 713 (35.6%) NA-TKA, and 856 (42.8%) conventional TKA.
RESULTS
Both technology-assisted approaches were associated with faster MCID achievement compared to conventional TKA. Using distribution-based thresholds, NA-TKA achieved MCID 29% faster (time ratio [TR] = 0.71, 95% confidence interval (CI): 0.58 to 0.88, P = 0.002) and RA-TKA 26% faster (TR = 0.74, 95% CI: 0.57 to 0.95, P = 0.018), with covariate-standardized estimated median times of 19.9, 20.7, and 28.0 days, respectively. Using anchor-based thresholds, NA-TKA achieved MCID 27% faster (TR = 0.73, 95% CI: 0.57 to 0.95, P = 0.017) and RA-TKA 26% faster (TR = 0.74, 95% CI: 0.55 to 1.00, P = 0.050), with corresponding median times of 52.8, 53.5, and 71.9 days. The one-year MCID attainment rates were similar across all techniques (P > 0.6 for both definitions).
CONCLUSIONS
Both RA-TKA and NA-TKA were associated with 26 to 29% faster achievement of clinically meaningful improvement compared with conventional TKA, corresponding to approximately seven to 19 fewer days to reach MCID, despite similar one-year attainment rates. Prospective multicenter studies are needed to validate these results and determine whether accelerated recovery translates to advantages in quality of life, healthcare utilization, and patient satisfaction.