New research presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting added to the growing body of evidence supporting robotic-assisted total joint arthroplasty (TJA).

The volume of robotic-assisted TJA procedures continues to grow, increasing 601.2% between 2015 and 2020. The research presented at AAOS showed higher patient satisfaction one year after total knee arthroplasty (TKA) and comparable infection rates between robotic-assisted and conventional total hip arthroplasty (THA).

Computer navigation and robotic tech used in TJA lets orthopedic surgeons offer three-dimensional planning before surgery and real-time sensory feedback during surgery. The tools help surgeons remove damaged bone and cartilage, position implants with more precision, and preserve healthy tissue.

Robotic-assisted total knee arthroplasty

The study evaluated whether robot-assisted TKA (raTKA) was associated with improved quality of life (QOL) and patient satisfaction compared to conventional TKA (cTKA) at one year post-op. QOL was assessed using the Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12) collected before surgery and at one year postoperatively. Patient satisfaction was assessed at one year using the International Society of Arthroplasty Registries (ISAR) satisfaction scale.

rTKA was associated with “significantly greater” QOL improvements among 1,154 patients included in the study. Multivariable regression demonstrated KOOS-12 QOL scores grew by an average of five more in the raTKA group compared to cTKA. For patients under 75 years old, raTKA was associated with 93.5% satisfied vs. 84.6% in the cTKA group.

“There are definite advantages regarding the reproducibility, accuracy, and precision of TKA with the robot and computer navigation, and this research demonstrates a clinically meaningful benefit for patients,” said David C. Ayers, MD, FAAOS, primary investigator and Distinguished Professor of Orthopaedic Surgery at UMass Chan Medical School in Worcester, Mass. “In the future, larger multicenter studies including well-designed randomized control trials are needed to validate these findings and evaluate their success across diverse patient populations and surgical settings.”

Robotic-assisted total hip arthroplasty

One concern surrounding robotic-assisted THA (raTHA) is whether increased operative time could increase the risk of infection.

“Robotic-assisted surgery introduces theoretical concerns, including increased operative time, additional instrumentation, and the potential for microbial entry through tracking pins or reference arrays,” said Josef Jolissaint, MD, primary investigator of the study and orthopedic surgeon at OrthoCarolina in Charlotte, N.C. “We wanted to determine whether those concerns translated into a higher infection risk for patients undergoing THA.”

Among the 31,795 primary THAs analyzed, 15,848 used conventional techniques and 15,947 used robotic or navigated techniques. There were no significant differences in superficial site infection (SSSI) or periprosthetic joint infection (PJI) rates between conventional and individual robotic techniques, despite a 4.4-minute increase in operative time for robotic-assisted procedures (91.5 vs. 87.1 minutes).

When analyzed as a cohort, robotic and navigated techniques had no significant difference in PJI (0.18% vs. 0.30%) or SSSI rates (0.18% vs. 0.26%) compared with conventional techniques.

“These findings reinforce that robotic-assisted and navigated approaches can be safely integrated into routine clinical practice, including academic and high-volume centers with trainees,” said Dr. Jolissaint. “As the demand for reproducible, high-quality outcomes for THA continues to grow, these technologies offer a safe pathway for enhancing surgical precision without compromising infection safety.”