Advances in Surgical Techniques for Robotic Computer-Navigated Total and Unicompartmental Knee Arthroplasty

Robotic-assisted knee arthroplasty has become increasingly commercially available as both technology developers and surgeons attempt to address specific limitations of conventional jig-based alignment techniques in order to improve resection accuracy and precision. Semi-active and passive systems predominate in the North American and European markets and can provide surgeons additional instruments for intraoperative calibration and balance assessment or directly assist in performing personalized resections. Recently published and ongoing clinical investigations seek to determine if robotic assistance may result in improved radiographic or clinical outcomes for patients undergoing either unicompartmental or total knee arthroplasty. A number of studies evaluating conventional and robotic-assisted knee arthroplasty did not identify significant radiographic or clinical outcome differences, though heterogeneity in robotic system design and application may limit the generalization of focused studies. Conversely, some studies that identified significant differences noted that robotic-assisted knee arthroplasty may be associated with fewer alignment outliers as well as increased surgical time—at least initially for unfamiliar surgeons. Further limitations include limited follow-up for newer systems on the market as well as the associated variety of arthroplasty implants and authors’ surgical techniques. Future studies will help surgeons and patients determine if intraoperative robotic assistance may be beneficial in total knee arthroplasty.