Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Linsen T. Samuel; Jaret M. Karnuta; Aditya Banerjee; Isaac Briskin; William A. Cantrell; Joseph W. George; Carlos A. Higuera-Rueda; Atul F. Kamath; Anton Khlopas; Alison Klika; Viktor E. Krebs; Nathan W. Mesko; Michael A. Mont; Trevor G. Murray; Nicolas S. Piuzzi; Paras Shah; Kim Stearns; Assem A. Sultan; Robert M. Molloy

doi:10.1055/s-0041-1731323

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2023; 36(01): 105-114
DOI: 10.1055/s-0041-1731323

Original Article

Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Authors

Linsen T. Samuel

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Jaret M. Karnuta

²School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
Aditya Banerjee

²School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
Isaac Briskin

³Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
William A. Cantrell

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Joseph W. George

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Carlos A. Higuera-Rueda

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Atul F. Kamath

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Anton Khlopas

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Alison Klika

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Viktor E. Krebs

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Nathan W. Mesko

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Michael A. Mont

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Trevor G. Murray

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Nicolas S. Piuzzi

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Paras Shah

²School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
Kim Stearns

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Assem A. Sultan

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Robert M. Molloy

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

Abstract

The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal–Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0–13.0] vs. 11.5 [9.5–15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.

Keywords

robotic arm-assisted - total knee arthroplasty - manual - postoperative outcomes - propensity score matched - patient-reported outcome measure

Full Text

References

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