Application and postoperative rehabilitation effects of HURWA, Cori, and Brainlab robots in TKA under the ERAS concept

Abstract As science and technology continue to progress, the variety and number of robots used in assisted total knee arthroplasty (TKA) have steadily increased, allowing more surgeons and patients to benefit from enhanced medical precision and improved knee joint function, ultimately leading to a better quality of life. This study conducted a retrospective analysis of 164 knee osteoarthritis patients who underwent either traditional or robot-assisted TKA following the Enhanced Recovery After Surgery (ERAS) protocol. The patients were divided into four groups according to the surgical approach and robotic system employed: traditional TKA group, Brainlab navigation system group (BRATKA group), domestic Hehua robot group (HRATKA group), and Stryker Cori robot group (CRATKA group). Data collected included basic patient information, imaging data, blood indicators, knee function, pain scores, complication rates, and in-hospital satisfaction.The results showed that under the ERAS protocol, the incision length in the robotic groups was longer than that in the conventional group (P > 0.05). The surgery times in the BRATKA group was longer than HRATKA group, while the TKA and CRATKA groups were shorter than them (P < 0.05). The HRATKA group performed better in terms of FFC (femoral-femoral contact) compared to the other groups (P < 0.05). The LFC (lateral femoral condyle) was comparable to the TKA group, smaller than the BRATKA and CRATKA groups (P < 0.05), The LTC (lateral tibial condyle) angle in the HRATKA group was nearer to 90° compared to the TKA group. No statistically significant differences were found between the groups in terms of HKA (hip-knee-ankle angle) and FTC (femoral-tibial contact) angles.On the third postoperative day, no significant differences were observed in the rate of knee swelling, length of hospital stay, changes in WBC, NLR, ESR, and CRP levels among the groups, or perioperative blood loss (P > 0.05). However, patients in the Brainlab group had higher resting VAS (Visual Analog Scale) and movement VAS scores compared to the other groups on day 3 post-operation (P < 0.05). At 90 days postoperatively, no statistically significant differences were found in VAS scores across the four groups. Additionally, there were no notable differences in KSS (Knee Society Score) or ROM (Range of Motion) scores postoperatively (P > 0.05).All four groups encountered common complications, including lower limb intermuscular venous thrombosis and wound exudation. Satisfaction rates exceeded 95% in all groups (P > 0.05). Under the ERAS protocol, despite differences in surgical approach, operation time, certain imaging data, and pain scores at 3 days post-operation, the three robotic systems demonstrated effective knee function recovery and patient satisfaction, comparable to the conventional TKA group, without increasing perioperative blood loss, inflammatory responses, or surgical complications. These findings suggest that robotic-assisted TKA, when applied under the ERAS protocol, leads to satisfactory clinical outcomes, further validating its role in improving surgical precision and promoting faster recovery.