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The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis

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Abstract

Purpose

The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function, pain, quality of life and satisfaction with surgery.

Methods

PubMed, Medline, Embase and CENTRAL were searched. Included were comparative studies investigating the effectiveness of semi-active or active robotic hip or knee arthroplasty compared to any other surgical intervention on function, pain, quality of life and satisfaction with surgery. Risk of bias and the strength of the evidence were assessed using the Downs and Black tool and the GRADE system, respectively. Relative risks, mean differences and 95% CI were calculated using random-effects models.

Results

Fourteen studies involving 1342 patients were included. All studies compared robotic to conventional surgery, with active robotic surgery evaluated in total hip or knee arthroplasty and semi-active robotic surgery in total hip or unicompartmental knee arthroplasty. Most studies presented some risk of bias, and the strength of evidence was rated as low to very low quality. Random-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short-, medium- and long-term follow-up. No significant difference in pain, quality of life and satisfaction with surgery were reported in individual studies.

Conclusions

This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery. Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain, quality of life and satisfaction with surgery is unclear.

PROSPERO Registration Number: CRD42017059932.

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Authors and Affiliations

  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), PO Box M157, Sydney, NSW, 2050, Australia

    Sascha Karunaratne & Daniel Steffens

  2. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    Michael Duan & Daniel Steffens

  3. Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia

    Evangelos Pappas

  4. Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia

    Brett Fritsch, Richard Boyle, Sanjeev Gupta, Paul Stalley & Mark Horsley

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  1. Sascha Karunaratne
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Correspondence to Sascha Karunaratne.

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Conflict of interest

Sascha Karunaratne, Michael Duan, Evangelos Pappas, Paul Stalley, Mark Horsley and Daniel Steffens declare that they have no conflict of interest.

Brett Fritsch owns stocks in Optimised Ortho and 360 Knee Systems; has performed consulting work for Optimised Ortho, 360 Knee Systems, Arthrex, Global Orthopaedics and Omni; and has received institutional support from Arthrex, Global Orthopaedics, Zimmer and Smith & Nephew.

Richard Boyle has performed consultancy work for Stryker, Adler, Signature and Global Orthopaedics and receives research assistance from Corin.

Sanjeev Gupta has performed consultancy work for Stryker, Depuy, Global Orthopaedics and Corin.

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Karunaratne, S., Duan, M., Pappas, E. et al. The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis. International Orthopaedics (SICOT) 43, 1283–1295 (2019). https://doi.org/10.1007/s00264-018-4140-3

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  • DOI: https://doi.org/10.1007/s00264-018-4140-3

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