Robotic vs Navigational vs Conventional Primary Total Knee Arthroplasty. Clinical and Radiological Long-Term Results with a Minimum Follow-up of 10 years -Survivalship Analysis-

The aim of this study was (1) to compare the clinical and radiological outcomes of robotic, navigational and conventional total knee arthroplasty with a minimum follow-up of 10 years, (2) to evaluate the survival rate, (3) and to estimate the accuracy of the three techniques by analyzing the outliers of the total knee arthroplasty (TKA) patients.Methods From January 1992 to December 2008, We evaluated 515 knees who underwent robotic TKA, navigational TKA, or conventional TKA with minimum follow-up of 10 years. Finally, this study including 92 patients (103 knees) who underwent robotic total knee arthroplasty using ROBODOC® , 197 patients (225 knees) who underwent navigational total knee arthroplasty using Orthopilot, and 175 patients (187 knees) who underwent conventional total knee arthroplasty. Hospital for special surgery(HSS) score, Knee Society Score(KSS), Western Ontario and McMaster Universities (WOMAC), and Range of Motion(ROM) were used for clinical evaluation. Mechanical alignment, implant radiological measurements and outliers were analyzed for radiological results. Complication related with surgery was also evaluated. Data were analyzed using SPSS Version 24.0 software and descriptive statistics, paired t‑test, one‑way ANOVA, and Wilcoxon tests. Kaplan-Meier survival analysis was performed for survival rate.Results All clinical assessments including HSS, KSS, WOMAC, and ROM at final follow-up showed excellent improvements in three groups (all, p<0.05), without any significant difference between the groups (p>0.05). In radiologic data, sagittal inclination of femoral implant in robotic group showed better result than another groups with significant difference(p<0.05). The cumulative survival rate was 94.8% in the robotic group, 96.2% in the navigation group, and 92.4% in the conventional TKA group with excellent survival (p=0.563). Complication rate associated surgery was 5.2 % in the robotic group, 5.3% in the navigation group, and 8% in the conventional groupConclusion Our study showed excellent survival with robotic, navigation and conventional TKA and similar clinical outcomes at long-term follow-up. However, in terms of radiological outcome robotic TKA showed accurate position of femoral component. With longer follow-up and larger cohort, the accuracy and effectiveness of robotic TKA on implant survival rate can be elucidated in the future.