Comparison of Patient Reported Outcomes After Robotic Versus Manual Total Knee Arthroplasty in the Same Patient Undergoing Staged Bilateral Knee Arthroplasty

Background: Robotic-assisted total knee arthroplasty (RATKA) has been proven to improve accuracy of component positioning and reducing alignment target outliers. However, the clinical benefit of robotics is often debated. Recent studies have shown reduced pain and faster recovery in the immediate post-operative period and may be associated with improved PROMs and satisfaction. The aim of this study was to assess PROMs and satisfaction in a unique patient population undergoing bilateral staged TKA to compare manual (MTKA) and RATKA in the same patient.

Methods: 55 patients underwent bilateral staged TKA, performed by a single surgeon at a single institute. Patients who underwent TKA for the first knee with manual technique and RATKA for the second side, were eligible for inclusion in the study. Primary outcome assessed was the Oxford Knee Score and secondary outcomes included the Forgotten Joint Score (FJS), patient satisfaction, mean duration for independent ambulation after TKA, and patient perspectives on recovery evaluated with a questionnaire.

Results: Both RATKA and MTKA were associated with comparable PROMs. Though RATKA was associated with improved joint perception (Mean FJS after MTKA surgery was 70.3 (SD = 10.66) and significantly lower than the mean FJS after RATKA (73, SD = 10.95, p-value < 0.01), but the difference was not clinically relevant. A higher proportion of patients were more likely to be very satisfied or satisfied after RATKA. A significant proportion of patients felt the knee operated with RATKA was less painful and felt more natural compared to MTKA at final follow-up (p < 0.01). Majority of patients would undergo RATKA again and recommend robotic-TKA to others.

Conclusion: Robotic-assisted surgery was associated with improved patient satisfaction, faster independent ambulation compared to manual techniques. PROMs however, were comparable without clinically significant differences. Patients preferred robotic-assisted surgery, with a significantly higher proportion perceiving knee operated by RATKA felt more natural.