Table 1.
Baseline characteristics included studies, (A) Semi-active system, (B) Active system, (C) Robotic system not mentioned
| Table 1 Author | Year | Study design | Device/System | Level of evidence | Aim | Study subjects | Complication/ Downside | COI | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (A) Semi-active system | ||||||||||||||||||||||||
| Bollars et al. | 2019 | Retrospective study | Smith & Nephew: NAVIO imageless surgical system, Memphis, TN, USA; semi-active System | IV | To determine whether there is a difference in the alignment accuracy between robotic and conventional TKA? Does the robot achieve the desired MA as planned by the surgeon’s preference? | 77 RATKA and 77 MTKA | *Time: significant longer operation time in the RATKA group | YES | ||||||||||||||||
| Cotter et al. | 2020 | Retrospective study | Stryker comp.: MAKO Surgical Corporation, Kalamazoo, MI; semi-active System | IV | To compare 90-day episode-of-care (EOC) costs for MTKA and RATKA | 147 RATKA and 139 MTKA | *Cost: Per minute operating cost was $14.44. RATKA group associated with longer surgical time. Higher intraoperative cost for RATKA vs. MTKA ($10,295.17 vs. 9,9998.78) Time: *Mean operative duration and mean total time spent in the operating room were significantly longer for RATKA group than MTKA (13.7 min vs 11.3 min) | YES | ||||||||||||||||
| Held et al. | 2021 | Retrospective study | Smith & Nephew: NAVIO imageless surgical system, Memphis, TN, USA; semi-active System | III | To investigate perioperative outcome, complications, and early patient-reported outcome measures (PROMs) of imageless RATKA system compared to conventional method | 111 imageless RATKA and 110 MTKA | *Blood loss: RATKA cohort exhibited a statistically significant longer surgical duration (123 min vs. 107 min) and resultant greater estimated blood loss (240 mL vs. 190 mL). *Iatrogenic Injury: 1 RATKA patient had patellar tendon rupture that underwent surgical repair. *Pin Fracture: 1 minimally displaced, uni-cortical tibial shaft stress fracture at the pin site that was manage non-operatively *Pin Infection: 3 wound complications in RATKA group at the pin sites *Time: RATKA had a significant longer surgical duration compared to MTKA (123 min vs 107 min) | YES | ||||||||||||||||
| Marchand et al. | 2020 | Prospective cohort study | Stryker comp.: MAKO Surgical Corporation, Fort Lauderdale, FL, USA; semi-active System | III | To compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA | 60 RATKA and 60 MTKA | *Learning curve: appears to be the steepest in early stage of adaptation of the RATKA (1 month mean = 81 min, 6-month mean = 65 min) | YES | ||||||||||||||||
| Mitchell et al. | 2021 | Retrospective study | Stryker comp.: MAKO Surgical Corporation, Mahwah, NJ, USA; semi-active System | IV | To compare outcomes of MTKA and RATKA | 148 RATKA and 139 MTKA | *Time: Mean tourniquet time was significantly longer in the RATKA group compared with MTKA (96.8 vs 91.6) | YES | ||||||||||||||||
| Naziri et al. | 2019 | Retrospective study | Stryker comp.: MAKO Surgical Corporation, Mahwah, NJ, USA, semi-active System | IV | To examining the learning curve associated with RATKA and comparing the surgeon’s robotics performance to his own traditional TKA | 40 RATKA and 40 MTKA | *Time: RATKA required greater overall surgical time than MTKA (82.5 min vs. 78.3 min) | NO | ||||||||||||||||
| Savov et al. | 2021 | Prospective Case–control study | Smith & Nephew: NAVIO imageless surgical system, Memphis, TN, USA; semi-active System | III | To determine the learning curve necessary to minimize the time of surgery. To evaluate the accuracy of the implant alignment when using an imageless robotic system for TKA | 70 RATKA and 70 MTKA | *Learning curve: for RATKA was completed after 11 cases | YES | ||||||||||||||||
| Smith et al. | 2019 | Prospective study | Stryker comp.: MAKO Surgical Corporation, Mahwah, NJ, USA; semi-active System | III | To determine if overall patient satisfaction can be improved with the use of robotic technology in TKA | 120 RATKA and 103 MTKA | * Stiffness: 9 manipulations under anesthesia and 6 arthroscopic lysis of adhesions were performed in the RA-TKA group. *Time: Average total operative time was higher in RATKA group than MTKA (96 min vs 86 min) | NO | ||||||||||||||||
| Vermue et al. | 2020 | Retrospective study | Stryker comp.: MAKO Surgical Corporation, Fort Lauderdale, FL, USA; semi-active System | IV | To identify and predict the learning curve of RATKA | 386 RATKA and 263 MTKA | *Learning curve: RA TKA was associated with a learning curve of 11–43 cases for operative time but not for the precision of limb alignment or component positioning. *Pin Fracture: 1 diaphyseal tibial stress fracture caused by the registration pin insertion. This healed uneventfully after 8 weeks. *Time: Operative time for the 10 RATKA cases were significantly longer than operative times prior to the introduction of the robotic system (RATKA 101.6 to 174.9 min vs 82.0 to 125.5 min) | NO | ||||||||||||||||
| Yun et al. | 2021 | Retrospective study | Stryker comp.: MAKO Surgical Corporation, Kalamazo, MI, USA; semi-active System | IV | To review the incidence of fracture with the conventional technique of bicortical diaphyseal pin placement. To evaluate a modified method of unicortical periarticular pin placement to mitigate this risk | 1702 RATKA | *Pin Fracture: Femoral shaft fractures occurred in 3 patients. Fractures sites lied at the femoral array pin-hole. Fractures were treated with intramedullary femoral rodding | NO | ||||||||||||||||
| (B) Active system | ||||||||||||||||||||||||
| Chun et al. | ||||||||||||||||||||||||
| 2011 | Retrospective study | Integrate Surgical systems Inc.: ROBODOC; Davis; CA, USA; active-System | IV | To elucidate and classify the causes of aborted RATKA and to find ways to reduce the incidence of these problems and to cope with them | 62 RATKA | * Abortion: 22 RATKA abonded; 2 aborted during preoperative planning, 5 after patient anesthesia (before skin incision), 5 after surgical exposure (before milling) and 10 after milling began | N/A | |||||||||||||||||
| Jeon et al. | 2019 | Retrospective study | Curexo Technology Corporation, ROBODOC, Sacramento, CA, USA; active System | IV | To determine whether robot-assisted TKA improve clinical outcomes compared to the conventional procedure? Does robot-assisted TKA improve accurate alignment of components and does this accuracy lead to longevity of the implant over a long-term follow-up period? | 94 RATKA and 334 MTKA | *Time: The mean tourniquet time was significantly different, being 45 min longer in the RATKA group than in the conventional TKA group (P < 0.001) | YES | ||||||||||||||||
| Kim et al. | 2019 | Prospective randomized, controlled study | Integrate Surgical systems Inc.: ROBODOC; Davis; CA, USA; active System | I | To compare RATKA to MTKA at long-term follow-up in terms of (1) functional results (2) radiographic parameters (3) Kaplan–Meier survivorship and (4) complications specific to RATKA | 975 RATKA and 990 MTKA | *Blood loss: Intraoperative blood loss (mL) were higher in RATKA vs. MTKA (261 to 255). Intraoperative drainage volume was higher in RATKA vs. MTKA (798.1 vs 775) *Time: Longer operation and tourniquet time for RATKA vs. MTKA (97 min to 69 min; 75 min to 38 min) | NO | ||||||||||||||||
| Liow et al. | 2016 | Prospective randomized study | Integrate Surgical systems Inc.: ROBODOC; Davis; CA, USA; active System | II | To determine whether there was improvement in functional outcomes and quality-of-life (QoL) measures between RATKA and CTKA | 31 RATKA and 29 MTKA | *Abandoned: RATKA has higher rate of complications, 7 complications observed in this study (5 RATKA vs. 2 MTKA) *RATKA aborted in 3 patients *Reason for abortion: one robot motor error, two technical error in the tibial work space | NO | ||||||||||||||||
| Mahure et al. | 2021 | Prospective cohort study | Tsolution One Total Knee Application; THINK Surgical System; active System | II | To assess the associated learning curve (LC) of active robot TKA | 115 patients for active robotic TKA | *Learning curve: Operative time of active robotic TKA significantly decreases after 10 cases. Variable results with LC for each surgeon ranging from 12 to 20 cases. *One definitive device-related complication (metallic tack left within the distal femur) that occurred in a single patient *Stiffness: *3 RATKA patients had postoperative stiffness | NO | ||||||||||||||||
| Park et al. | 2007 | Prospective randomized study | Integrate Surgical systems Inc.: ROBODOC; Davis; CA, USA; active System | II | To compare RATKA and MTKA | 32 RATKA and 30 MTKA | *Iatrogenic Injury: Complication in RATKA group: 1 patellar tendon rupture, 1 dislocation of the patella, 1 postoperative supracondylar fracture, 1 patellar fracture, and 1 peroneal injury *Pin Fracture: *1 postoperative supracondylar fracture in RATKA | N/A | ||||||||||||||||
| Siebert et al. | 2002 | Prospective study | U.R.S.-ortho GMbH & Co. KG, CASPAR, Rastatt, Germany; active System | III | To evaluate precision and accuracy of RATKA | 70 RATKA and 52 MTKA | *Abortion: 1 RATKA aborted due to a defective registration marker *Learning curve: was noted with significantly longer operating times for the first cases. *Pin Infection: *3 RATKA patients had superficial skin irritations at the pin sites. *Time: longer operating time for RATKA for the first patients and almost normal operating times for later patients (135 v/s 90 min) | NO | ||||||||||||||||
| Song et al. | 2012 | Prospective randomized study | Integrate Surgical systems Inc.: ROBODOC; Davis; CA, USA; active System | I | To determine whether RATKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the gap balance; and (4) reduced complications | 50 RATKA and 50 MTKA | *Iatrogenic Injury: In RATKA 2 patellar tendon abrasion. *Pin Infection: 1 RATKA patient had a seroma at the pin site. *Time: Mean operative time was 25 min longer for RATKA compared to MTKA group (99 min vs 74 min) | YES | ||||||||||||||||
| (C) Robotic system not mentioned | ||||||||||||||||||||||||
| Antonios et al. | 2019 | Retrospective study | N/A (not available) | IV | To analyze trends in the use of technology-assisted TKA, identify factors associated with the use of these technologies, and describe potential drivers of cost | 273,922 CATKA and 24,084 used RATKA | *Cost: Mean hospital charge for a RATKA has increased by 52.4% in the past 15 years | YES | ||||||||||||||||
| Kayani et al. | 2018 | Prospective cohort study | N/A | II | To determine learning curve for RATKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. To compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic arm-assisted TKA | 60 RATKA and 60 MTKA | *Learning curve: RATKA was associated with a learning curve of seven cases for operative times and surgical team comfort levels *Pin Infection: 1 RATKA patient had minor wound dehiscence over the incision for the proximal tibial registration pins that was treated with regular dressings and prophylactic oral antibiotics | N/A | ||||||||||||||||
| Ofa et al. | 2020 | Retrospective cohort study | N/A | III | To investigate the differences between robotic TKA and non-robotic TKA on perioperative and postoperative complications and opioid consumption | 5,228 RATKA and 750,122 MTKA | *Length of stay: Patients underwent RATKA had a longer hospital stay (4.38 vs 3.00) | NO | ||||||||||||||||