Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 9; pp. 2942 - 2951
• Main Authors: Liow, Ming Han Lincoln, Goh, Graham Seow-Hng, Wong, Merng Koon, Chin, Pak Lin, Tay, Darren Keng-Jin, Yeo, Seng-Jin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2017; Springer Nature B.V
• Subjects: Aged; Arthroplasty (knee); Arthroplasty, Replacement, Knee - methods; Biomedical materials; Clinical trials; Complications; Emotions; Female; Follow-Up Studies; Humans; Joint surgery; Knee; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis, Knee - surgery; Outliers (statistics); Patient satisfaction; Patients; Prospective Studies; Quality of Life; Robotic surgery; Robotic Surgical Procedures; Robotics; Surgical implants; Robotic-assisted total knee arthroplasty; ROBODOC; Robotic knee surgery; Functional outcomes; Minimal clinically important difference
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-016-4076-3

Purpose
Despite reduction in radiological outliers in previous randomized trials comparing robotic-assisted versus conventional total knee arthroplasty (TKA), no differences in short-term functional outcomes were observed. The aim of this study was to determine whether there was improvement in functional outcomes and quality-of-life (QoL) measures between robotic-assisted and conventional TKA.
Methods
All 60 knees (31 robotic-assisted; 29 conventional) from a previous randomized trial were available for analysis. Differences in range of motion, Knee Society (KSS) knee and function scores, Oxford Knee scores (OKS), SF-36 subscale and summative (physical PCS/mental component scores MCS) were analysed. In addition, patient satisfaction, fulfilment of expectations and the proportion attaining a minimum clinically important difference (MCID) in KSS, OKS and SF-36 were studied.
Results
Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years. Despite having a higher rate of complications, the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures, with significant differences in SF-36 vitality (
p
 = 0.03), role emotional (
p
 = 0.02) and a larger proportion of patients achieving SF-36 vitality MCID (48.4 vs 13.8 %,
p
 = 0.009). No significant differences in KSS, OKS or satisfaction/expectation rates were noted.
Conclusion
Subtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA. This finding suggests that QoL measures may be more sensitive and clinically important than surgeon-driven objective scores in detecting subtle functional improvements in robotic-assisted TKA patients.
Level of evidence
II.