Is robotic-arm-assisted total knee arthroplasty less traumatic? A meta-analysis

Objective was to identify inflammatory responses that predict postoperative total knee arthroplasty (TKA) outcome. The robotic TKA has resulted decreased tissue trauma. This review aims to determine the level 1 evidence of inflammatory responses following robotic and conventional jig-based TKA as inflammatory markers provide an objective method for assessing the invasiveness of the surgery. A systematic search according to the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) of the existing literature was performed on the electronic databases PubMed, Scopus and Ovid until the 1st of June 2023. Inclusion criteria were randomized controlled trials (RCTs), written in the English language and published in the last ten years, focusing on studies that evaluated the influence of inflammatory markers (O) on robotic TKA (I) and conventional jig based (C) TKA in end-stage knee osteoarthritis patients (P) were included in the study. The inverse variance method analyzed continuous outcomes as standard mean difference (SMD), random effect model and 95% confidence intervals (CI). In total, among the 557 articles, four studies were included. One hundred sixty-five patients were included, and various inflammatory markers and patient-reported outcome measures were analysed. This meta-analysis showed that R-TKA showed a decreased inflammatory response compared to C-TKA [interleukin (IL)-6 (Std. mean diff. {IV, random, 95 CI}=-1.22 {-1.78, -0.66}, C reactive protein (CRP) (-1.07 {-2.01, -0.13}, erythrocyte sedimentation rate (ESR)=-0.65 {-1.17,-0.12} with a significant p<0.05] with no significant changes in terms of patient-reported outcome measures Western Ontario and McMaster universities osteoarthritis index (WOMAC)=-0.25 {-0.59,0.09}, knee society score (KSS)=0.18 {-0.34, 0.70}, and functional outcome range of motion (ROM)=-0.22 {-0.62, 0.17} with a p>0.05. Robotic-arm-assisted TKA has decreased early postoperative inflammatory response. High powered studies assessing the predictive value of metabolic and inflammatory factors pre and post-surgery and the already evidenced risk factors with follow-up greater than one year after TKA are warranted.