Computer-Navigated and Robotic-Assisted Total Knee Arthroplasty: Increasing in Popularity Without Increasing Complications

Jennifer C Wang; Amit S Piple; William J Hill; Matthew S Chen; Brandon S Gettleman; Mary Richardson; Nathanael D Heckmann; Alexander B Christ

doi:10.1016/j.arth.2022.06.014

Computer-Navigated and Robotic-Assisted Total Knee Arthroplasty: Increasing in Popularity Without Increasing Complications

J Arthroplasty. 2022 Dec;37(12):2358-2364. doi: 10.1016/j.arth.2022.06.014. Epub 2022 Jun 20.

Authors

Jennifer C Wang¹, Amit S Piple¹, William J Hill¹, Matthew S Chen¹, Brandon S Gettleman², Mary Richardson¹, Nathanael D Heckmann¹, Alexander B Christ¹

Affiliations

¹ Keck School of Medicine of USC, Los Angeles, California.
² Keck School of Medicine of USC, Los Angeles, California; University of South Carolina School of Medicine, Columbia, South Carolina.

PMID: 35738360
DOI: 10.1016/j.arth.2022.06.014

Abstract

Background: Data on the clinical impact of computer navigation (CN) and robotic assistance (RA) in total knee arthroplasty (TKA) are mixed. This study aims to describe modern utilization trends in CN-TKA, RA-TKA, and traditionally-instrumented (TD) TKA and to assess for differences in postoperative complications and opioid consumption by procedure type.

Methods: A national database was queried to identify primary, elective TKA patients from 2015 to 2020. Trends in procedural utilization rates were assessed. Differences in 90-day postoperative complications and inpatient opioid consumption were assessed. Multivariate regression analyses were performed to account for potential confounders.

Results: Of the 847,496 patients included, 49,317 (5.82%) and 24,460 (2.89%) underwent CN-TKA and RA-TKA, respectively. CN-TKA utilization increased from 5.64% (2015) to 6.41% (2020) and RA-TKA utilization increased from 0.84% (2015) to 5.89% (2020). After adjusting for confounders, CN-TKA was associated with lower periprosthetic joint infection (P = .001), pulmonary embolism (P < .001), and acute respiratory failure (P = .015) risk compared to traditional (TD) TKA. RA-TKA was associated with lower deep vein thrombosis (P < .001), myocardial infarction (P = .013), and pulmonary embolism (P = .001) risk than TD-TKA. Lower postoperative day 1 opioid usage was seen with CN-TKA and RA-TKA than TD-TKA (P < .001). Lower postoperative day 0 opioid consumption was also seen in RA-TKA (P < .001).

Conclusion: From 2015 to 2020, there was a relative 13.7% and 601.2% increase in CN-TKAs and RA-TKAs, respectively. This trend was associated with reductions in hospitalization duration, postoperative complications, and opioid consumption. These data support the safety of RA-TKA and CN-TKA compared to TD-TKA. Further investigation into the specific indications for these technology-assisted TKAs is warranted.

Keywords: complications; computer navigation; opioids; robotic assistance; total knee arthroplasty; trends.

MeSH terms

Analgesics, Opioid / therapeutic use
Arthroplasty, Replacement, Knee* / adverse effects
Arthroplasty, Replacement, Knee* / methods
Computers
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Pulmonary Embolism* / complications
Robotic Surgical Procedures* / adverse effects

Substances

Analgesics, Opioid