JAAOS - 2026-07-31 - Journal Article
Implant-Related Complications After Robotic-Assisted Versus Manual Revision Knee Arthroplasty: A Propensity-Matched Cohort Study.
Mzeihem M, Rteil A, Farid Y, Martini O, Piponov H, Puri L, Amirouche F
Topics
Key Takeaway
Robotic-assisted revision TKA demonstrated a 52% higher hazard of mechanical implant-related complications in the manual group at 1 year (HR 1.52) and a significantly higher 3-year revision rate in manual cases (13.5% vs. 11.4%, OR 1.22).
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Summary
This study used the TriNetX Collaborative Network to compare implant-related complications between robotic-assisted and manual revision TKA after 1:1 propensity score matching for demographics, comorbidities, and revision history. Robotic-assisted revision TKA showed significantly lower mechanical implant-related complications at 3 and 6 months (OR 1.67 and 1.66), lower instability at 1 year (OR 1.59), and lower opioid use throughout 3 years of follow-up. PJI, readmission, patellar dislocation, wound infection, and transfusion rates did not differ, but manual revision TKA had a higher 3-year revision rate (13.5% vs. 11.4%, OR 1.22, P=0.03).
Key Limitation
The database methodology cannot capture bone loss grade, implant constraint level, or revision indication, all of which are primary determinants of revision TKA outcome and likely differ systematically between robotic and manual cohorts despite propensity matching.
Original Abstract
INTRODUCTION
As robotic-assisted total knee arthroplasty (TKA) gains traction in revision procedures, the urgent need to investigate its effectiveness compared with manual methods becomes apparent.
METHODS
Data were retrospectively obtained from the TriNetX Collaborative Network. Revision TKA (rKA) cases were identified using CPT codes and categorized as manual or robotic assisted using ICD-10 procedure codes. Cohorts were balanced with 1:1 propensity score matching for demographics, comorbidities, and revision history. Complication rates were compared across follow-up using chi-square analysis.
RESULTS
An initial query identified 19,088 manual and 2,709 robotic-assisted rKA cases. After 1:1 propensity matching, 2,010 patients remained in each group. Robotic rKA had significantly lower mechanical implant‑related complications at 3 and 6 months (OR 1.67 and 1.66; P < 0.001) and lower early VTE, while PJI, readmission, and revision rates were not significantly different. Manual rKA showed higher opioid use at 0 to 3 months (OR 1.40, 95% CI, 1.14 to 1.71, P < 0.001) and 3 to 6 months (OR 1.28, 95% CI, 1.12 to 1.47, P < 0.001) and throughout the 3 years of follow-up.Throughout the follow-up period, patellar dislocation, wound infection, non‑implant-related complications, and transfusion did not differ. At 1 year, manual rKA had higher instability (OR 1.59; P = 0.001) and higher hazard of mechanical implant‑related complications (HR 1.52, 95% CI, 1.32 to 1.75; P = 0.049). Instability, loosening, and periprosthetic fracture remained higher at 2 to 3 years, and revision was significantly more frequent at 3 years (13.5% vs. 11.4%; OR 1.22, 95% CI, 1.02 to 1.46; P = 0.03).
DISCUSSION
Robotic-assisted rKA was associated with markedly lower mechanical implant‑related complications across early and midterm follow-up, including reduced rates of instability, aseptic loosening, periprosthetic fracture, VTE, and lower opioid requirements. Rates of PJI, readmission, and revision were largely comparable, although manual rKA demonstrated a markedly higher revision rate by 3 years. These findings suggest that robotic assistance may improve implant reliability and postoperative recovery, but prospective studies and cost-effectiveness analyses remain necessary.