Use of Robotic-Assisted TKA Has Grown Substantially, Study Finds

    Although still representing a small percentage of total knee arthroplasty (TKA) procedures performed in the US, nationwide use of a robotic system for TKA grew more than 2000% between 2010 and 2018, according to recent study from Hospital for Special Surgery.

    The researchers also found a lower rate of complications in the first 3 months after surgery for robotic-assisted TKA compared with conventional TKA.

    “The use of computer-assisted navigation and robotic assistance for total knee replacement has increased tremendously and shows no sign of slowing down,” said senior author Geoffrey H. Westrich, MD. “Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision.” [1,2]

    The study by Dr. Westrich and his colleagues at Hospital for Special Surgery was published online by Arthroplasty Today.

    Trends in Technology-Assisted TKA

    The goal of the study was to update the literature on trends in technology-assisted TKA, which included examining the 90-day complication rate requiring readmission to the hospital after surgery. “Although both computer-assisted navigation and robotic-assisted knee replacement have demonstrated increased precision with component positioning and alignment, it is unclear if this translates into improved clinical outcomes,” Dr. Westrich said. [3,4]

    RELATED: Robotic-Assisted TKA in a Patient with Multiple Hereditary Exostoses

    Using the PearlDiver All Payer Claims Database, the researchers identified more than 1.3 million patients who had undergone primary, elective TKA between 2010 and 2018. Then, using the International Classification of Diseases 9th or 10th revision and Current Procedural Technology codes, they divided these patients into 3 groups:

    • Conventional TKA (n = 1,213,038)
    • Computer-navigated TKA (n = 89,715)
    • Robotic-assisted TKA (n = 4658)

    Analysis of Utilization and Complication Rates

    When analyzing the data, the researchers found that:

    • While the use of computer navigation increased by 32% from 2010 to 2018, the use of robotics increased by 2204%. The biggest increases were between 2016 and 2018.
    • Overall, surgeons in the western region of the US had the highest use of technology assistance for TKA and surgeons in the midwest had the lowest use, although use of technology increased in all regions between 2010 and 2018: 98% increase in the midwest, 49% in the south, 48% in the northeast, and 42% in the west.
    • The rate of all-cause 90-day complications requiring readmission was lowest in the robotic-assisted TKA group and highest in the conventional TKA group. That was true of all time points in the study.
    • The rate of all-cause 90-day complications requiring readmission was higher for the computer-navigated TKA group than for the robotic-assisted TKA group, but lower than for the conventional TKA group.
    • The 90-day readmission rates were similar among the groups for periprosthetic fracture and infection.

    “Robotic-assisted surgery had significantly lower odds of all-cause 90-day complications requiring readmission to the hospital, with a rate of 1.57%, compared [with] conventional knee replacement, which had a complication rate of 2.55%,” Dr. Westrich noted. “The data imply that for every 102 patients treated with robotic-assisted knee replacement, 1 readmission may be avoided.”

    Concluding Thoughts

    With robotic-assisted TKA, a digital tracking system constantly monitors and updates the patient’s anatomy during the procedure, enabling the surgeon to make real‐time adjustments to optimize implant placement, alignment, ligament balance, and joint motion. This provides each patient with a personalized surgery tailored to his or her individual anatomy.

    “The advantage of the robotic system is that it allows us to customize the procedure for each patient,” Dr. Westrich said. “It enables optimal alignment and positioning of the knee implant, as well as optimal ligament balancing, important to the long-term success of the surgery.

    Although additional studies of longer-term outcomes will be needed, Dr. Westrich said that “with more accurate alignment and positioning, the implant should experience less wear and friction, and it could ultimately last longer.”


    Bendich I, Kapadia M, Alpaugh K, Diane A, Vigdorchik J, Westrich G. Trends of utilization and 90-day complication rates for computer-assisted navigation and robotic assistance for total knee arthroplasty in the United States from 2010 to 2018. Arthroplast Today. 2021 Sep 9;11:134-139. doi: 10.1016/j.artd.2021.08.005. eCollection 2021 Oct.


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    2. Sherman WF, Wu VJ. Robotic surgery in total joint arthroplasty: a Survey of the AAHKS membership to Understand the utilization, Motivations, and Perceptions of total joint surgeons. J Arthroplasty. 2020;35(12):3474.
    3. Sousa PL, Sculco PK, Mayman DJ, Jerabek SA, Ast MP, Chalmers BP. Robots in the operating room during hip and knee arthroplasty. Curr Rev Musculoskelet Med. 2020;13(3):309.
    4. Harvie P, Sloan K, Beaver RJ. Computer navigation vs conventional total knee arthroplasty: five-year functional results of a prospective randomized trial. J Arthroplasty. 2012;27(5):667.