Multiple Robotic-Assisted Systems Versus Conventional Total Knee Arthroplasty: A Comparison of Two-Year Clinical Outcomes

BACKGROUND: While robotic-assisted (RA) total knee arthroplasty (TKA) offers improved precision in bone resection and implant alignment, disagreement exists regarding its clinical benefit compared to conventional TKA (conv-TKA), particularly concerning patient-reported outcome measures (PROMs). Multiple RA-TKA systems are in use, yet few studies compare outcomes among these systems. We aimed to report differences in clinical outcomes among two RA-TKA systems (i.e., Mako®, ROSA®) and conv-TKA. METHODS: This retrospective cohort study included TKAs performed by a single fellowship-trained orthopedic surgeon from January 1, 2016, to April 14, 2023. The electronic health record was reviewed for patient demographics and postoperative complications. PROMs (Short Form Health Survey (SF-12) and Oxford Knee Score (OKS)) were collected preoperatively and postoperatively (six months, one year, and two years) and analyzed using adjusted pairwise t-tests. Complication and revision rates were summarized using descriptive statistics. RESULTS: A total of 167 primary TKAs (n = 74 Mako, n = 29 ROSA, n = 64 conv-TKA) were included. At the six-month follow-up, the ROSA-TKA cohort had a significantly lower OKS than the conv-TKA cohort (-4.38, p = 0.042). Similarly, the Mako-TKA cohort had a significantly higher OKS than the ROSA-TKA cohort (4.79, p = 0.02). There were no significant differences in PROMs at the remaining follow-ups or in other pairwise comparisons. There was no statistically significant difference among groups in 90-day complications or TKA revisions. CONCLUSIONS: Surgeons can achieve comparable clinical outcomes using various RA-TKA systems or conventional implants, without increased complications or revisions, while leveraging the enhanced implant placement accuracy of RA-TKA.