Comparable results in total knee arthroplasty using the ROSA knee system versus the conventional technique: A retrospective propensity‐matched cohort study

Abstract Purpose Robotic‐assisted total knee arthroplasty (RA‐TKA) is an increasingly popular alternative that may increase the accuracy of conventional TKA techniques. This study aims to evaluate RA‐TKA accuracy and compare its radiographic and clinical outcomes to conventional TKA (cTKA). Methods A retrospective examination of patients with bi‐ or tricompartmental knee osteoarthritis who underwent RA‐TKA (RObotic Surgical Assistant system) or cTKA and were prospectively documented in the TKA registry. Accuracy was assessed using standardized radiographic implant position evaluations, namely femoral and tibial coronal angles and femoral and tibial sagittal angles. Baseline demographics, surgery details and 6‐ and 12‐month post‐TKA patient‐reported outcomes (PROMs; e.g., Oxford Knee Score [OKS] and Core Outcome Measures Index) were compared between RA‐TKA and propensity score‐matched cTKA patients. Results Overall correlation between preset and 6‐week postoperative angle measurements for RA‐TKA was low with significant differences noted only for mean tibial sagittal angles (84.6° [RA‐TKA] vs. 82.3° [cTKA]) ( p < 0.001). The study groups were demographically similar, although RA‐TKA patients had slightly longer operative times and higher blood loss but shorter inpatient stays. There were sustainable improvements in all PROMs already at 6 months, yet RA‐TKA patients had significantly higher OKS values over their conventional counterparts at this time point. Conclusion Radiological and clinical outcomes were comparable between RA‐TKA and cTKA. The robotic‐assisted system demonstrated higher accuracy in the coronal than sagittal plane and RA‐TKA patients achieved better short‐term outcomes for pain and disability. While both methods are similar in the hands of a skilled surgeon, long‐term studies are necessary to establish clear method superiority. Level of Evidence Level III, therapeutic study.