No difference in short-term revision risk between robot-assisted total knee arthroplasty and conventional techniques: An analysis of 79,115 total knee arthroplasties in the Dutch arthroplasty register.

Background

Total knee arthroplasty (TKA) is used for treatment of end-stage knee osteoarthritis (OA). Incidence of both OA and TKA is rising. Robot-assisted TKA (RA-TKA) is gaining popularity, the innovation is appealing to surgeons, hospitals and patients. Prior literature reports contrasting results: some suggesting superior outcomes for RA-TKA, others reporting non-inferior or comparable outcomes. This study aimed to evaluate short-term revision risk of RA-TKA compared to conventional TKA (cTKA), using real-world registry data.

Methods

5535 RA-TKAs and 73,580 cTKAs performed between 2022 and 2024 were included from the Dutch Arthroplasty Register (LROI). Competing risk analyses and multivariable Cox-regression analyses were used to assess differences in implant survival between RA-TKA and cTKA. Four major RA-TKA manufacturers were compared separately. Differences in patient characteristics and reasons for revision were evaluated.

Results

Crude cumulative incidence of revision at 2 years follow-up was 1.8% (CI 1.4-2.3) for RA-TKA and 2.4% (2.3-2.6) for cTKA. After adjustment for confounders, the risk of revision was not significantly different: HR 0.9 (0.7-1.1). We found no significant differences between manufacturers.

Interpretation

In this nationwide analysis, RA-TKA and cTKA demonstrated comparable short-term revision outcomes, with overall revision rates remaining low in both groups. Nonetheless, mean follow-up time was short, so additional research is required to evaluate mid- to long-term results and to indicate potential superiority of one technique over another.