Evaluating the impact of robotic-assisted total knee arthroplasty on quality of care through patient-reported outcome measures in a third-level hospital in Italy: A prospective cohort study

Davide Golinelli; Federico Polidoro; Simona Rosa; Agnese Puzzo; Giovanni Guerra; Stefano Raimondi; Antonio Chiaravalloti; Valentina Sisti; Francesco Sanmarchi; Francesca Bravi; Roberto Grilli; Maria Pia Fantini; Alberto Belluati

doi:10.1016/j.knee.2024.10.009

Evaluating the impact of robotic-assisted total knee arthroplasty on quality of care through patient-reported outcome measures in a third-level hospital in Italy: A prospective cohort study

Knee. 2024 Nov 8:52:32-42. doi: 10.1016/j.knee.2024.10.009. Online ahead of print.

Affiliations

¹ Health Services Research, Evaluation and Policy Unit, AUSL Della Romagna, Ravenna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Link Campus University, Rome, Italy. Electronic address: [email protected].
² Division of Orthopedics, S. Maria Delle Croci Hospital, AUSL Della Romagna, Ravenna, Italy.
³ Health Services Research, Evaluation and Policy Unit, AUSL Della Romagna, Ravenna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
⁴ Director of Clinical Activities, AUSL Della Romagna, Ravenna, Italy.
⁵ Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
⁶ Health Services Research, Evaluation and Policy Unit, AUSL Della Romagna, Ravenna, Italy.

PMID: 39520805
DOI: 10.1016/j.knee.2024.10.009

Abstract

Background: With the shift towards personalized medicine, understanding the impact of robotic-assisted total knee arthroplasty (TKA) on patient-reported outcome measures (PROMs) is essential for evaluating its effectiveness and patient satisfaction. The QUAROB (Quality-assessment-of-ROBotic-orthopedic-surgery) study aims at assessing the impact of robotic surgery on quality of care and joint functionality at 6 months post-surgery among patients undergoing robotic-assisted TKA.

Methods: This observational, prospective cohort study included patients from Ravenna Hospital, Italy, who underwent elective robotic TKA (2022-2023), and a historical cohort who underwent traditional TKA (2019). PROMs questionnaires (EuropeanQualityofLife-Visual AnalogScale, EQ-VAS, EuropeanQualityofLife-5Dimensions-3Likert, EQ-5D-3L, and KneeinjuryOsteoarthritisOutcomeScore-PatientSatisfaction, KOOS-PS) were administered within 30 days before surgery and 6 months post-surgery. Statistical analysis involved comparing baseline and follow-up PROMs, focusing on patients achieving at least a 10% improvement (Minimal Clinically Important Difference, MCID).

Results: The study enrolled 214 robotic surgery patients, with 208 completing baseline and 103 completing 6-month follow-up questionnaires. Patients undergoing robotic-assisted TKA demonstrated significant improvements in EQ-VAS, EQ-5D-3L, and KOOS-PS scores at 6 months. A significant proportion of patients achieved improvements exceeding the MCID threshold (68.9% for EQ-VAS, 58.3% for EQ-5D-3L, and 68.9% for KOOS-PS). Robotic TKA patients experienced shorter hospital stays (7 vs. 9 days, p < 0.001) and higher engagement in rehabilitation compared to traditional TKA patients.

Conclusions: The QUAROB study provides evidence of the impact and benefits of robotic-assisted TKA, highlighting significant enhancements in PROMs, reduced hospital stays, and increased rehabilitation engagement. These outcomes reinforce the role of robotic technology in improving surgical precision and patient satisfaction in orthopedic surgery.

Keywords: Joint functionality; Minimal Clinically Important Difference (MCID); Orthopedic surgery; Quality of care; Robotic-assisted knee arthroplasty; patient-reported outcome measures (PROMS).