Lower Perioperative Complication Rates and Shorter Lengths of Hospital Stay Associated With Technology-Assisted Total Knee Arthroplasty Versus Conventional Instrumentation in Primary Total Knee Arthroplasty

David S Constantinescu; Joseph P Costello 2nd; Ramakanth R Yakkanti; Dennis J Vanden Berge; Jaime A Carvajal Alba; Victor H Hernandez; Michele R D'Apuzzo

doi:10.1016/j.arth.2023.12.015

Lower Perioperative Complication Rates and Shorter Lengths of Hospital Stay Associated With Technology-Assisted Total Knee Arthroplasty Versus Conventional Instrumentation in Primary Total Knee Arthroplasty

J Arthroplasty. 2023 Dec 14:S0883-5403(23)01207-X. doi: 10.1016/j.arth.2023.12.015. Online ahead of print.

Authors

David S Constantinescu¹, Joseph P Costello 2nd¹, Ramakanth R Yakkanti², Dennis J Vanden Berge¹, Jaime A Carvajal Alba¹, Victor H Hernandez¹, Michele R D'Apuzzo¹

Affiliations

¹ Department of Orthopaedics, University of Miami, Miami, Florida.
² Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Jefferson Health, Philadelphia, Pennsylvania.

PMID: 38103801
DOI: 10.1016/j.arth.2023.12.015

Abstract

Background: The use of technology allows increased precision in component positioning in total knee arthroplasty (TKA). The objectives of this study were to compare (1) perioperative complications and (2) resource utilization between robotic-assisted (RA) and computer-navigated (CN) versus conventional (CI) TKA.

Methods: A retrospective cohort study was performed using a national database to identify patients undergoing unilateral, primary elective TKA from January 2016 to December 2019. A total of 2,174,685 patients were identified and included RA (69,445), CN (112,225), or CI (1,993,015) TKA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analysis was performed.

Results: The RA TKA cohort had lower rates of intraoperative fracture (0.05 versus 0.08%, P < .05), respiratory complications (0.6 versus 1.1%, P < .05), renal failure (1.3 versus 1.7%, P < .05), delirium (0.1 versus 0.2%, P < .05), gastrointestinal complications (0.04 versus 0.09%, P < .05), postoperative anemia (8.9 versus 13.9%, P < .05), blood transfusion (0.4 versus 0.9%, P < .05), pulmonary embolism, and deep vein thrombosis (0.1 versus 0.2%, P < .05), and mortality (0.01 versus 0.02%, P < .05) compared to conventional TKA, though the cohort did have higher rates of myocardial infarction (0.09 versus 0.07%, P < .05). The CN cohort had lower rates of myocardial infarction (0.02 versus 0.07%, P < .05), respiratory complications (0.8 versus 1.1%, P < .05), renal failure (1.5 versus 1.7%, P < .05), blood transfusion (0.8 versus 0.9%, P < .05), pulmonary embolism (0.08 versus 0.2%, P < .05), and deep vein thrombosis (0.2 versus 0.2%, P < .05) over CI TKA. Total cost was increased in RA (16,190 versus $15,133, P < .05) and CN (17,448 versus $15,133, P < .05). However, the length of hospital stay was decreased in both RA (1.8 versus 2.2 days, P < .05) and CN (2.1 versus 2.2 days, P < .05).

Conclusions: Technology-assisted TKA was associated with lower perioperative complication rates and faster recovery.

Keywords: TKA; complications; computer navigated; perioperative outcomes; robotic-assisted; total knee arthroplasty.