Patient‐reported outcomes are comparable between imageless robotic‐assisted and computer‐navigated total knee arthroplasty: A retrospective cohort study

Abstract Purpose The benefits of computer‐navigated total knee arthroplasty (CN‐TKA) are well established, and although early studies have demonstrated some benefits of robotic‐assisted total knee arthroplasty (RA‐TKA), there is limited evidence on the clinical and patient‐reported outcome measures (PROMs) directly compared to CN‐TKA. As RA‐TKA continues to gain popularity, it is important to compare outcomes with the more established technique to justify its use. This study compares PROMs for imageless RA‐TKA versus CN‐TKA, and between RA‐TKA performed with either ROSA or CORI. Methods This was a retrospective study of prospectively collected data of patients who underwent primary TKA for osteoarthritis (OA). The study included consecutive surgeries between December 2021 and April 2023, utilising imageless RA‐TKA (ROSA or CORI) or CN‐TKA. PROMs were obtained preoperatively, at 3 months, and at 12 months, including the Oxford knee score (OKS), Forgotten Joint Score (FJS), Veterans Rand 12‐item mental and physical health survey (VR‐12), pain (visual analogue scale [VAS]) and patient satisfaction scores. Results A total of 399 patients were recruited: 212 underwent RA‐TKA (CORI: n = 104; ROSA: n = 108), and 187 underwent CN‐TKA. There were no significant differences between groups at baseline. At 12 months, patient satisfaction with medical care favoured CN‐TKA (adjusted mean difference: –3.94; 95% CI: –7.44, –0.45). Between ROSA and CORI systems, patients' subjective knee normality score favoured CORI (adjusted mean difference: –8.44; 95% CI: –16.0, –0.90). No other meaningful differences were observed in either comparison. Conclusion This study showed no difference in PROMS (OKS and FJS) between CN‐TKA and RA‐TKA; however, a modest benefit was seen in patient satisfaction with medical care favouring CN‐TKA. Similarly, only a modest difference was identified between ROSA and CORI, with knee joint normality favouring the CORI system. These findings demonstrate no clear short‐term benefit for well‐established navigation surgeons to change to robotic techniques, although further investigations would be valuable. Level of Evidence Level III.