Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score-Matched Patient Cohorts

Cole C Howell; Sietske Witvoet; Laura Scholl; Andrea Coppolecchia; Manoshi Bhowmik-Stoker; Antonia F Chen

doi:10.5435/JAAOS-D-23-01117

Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score-Matched Patient Cohorts

J Am Acad Orthop Surg. 2024 Jul 19. doi: 10.5435/JAAOS-D-23-01117. Online ahead of print.

Authors

Cole C Howell¹, Sietske Witvoet, Laura Scholl, Andrea Coppolecchia, Manoshi Bhowmik-Stoker, Antonia F Chen

Affiliation

¹ From the Albany Medical College, Albany, NY (Howell), Stryker, Amsterdam, the Netherlands (Witvoet), the Stryker, Mahwah, NJ (Scholl, Coppolecchia, and Bhowmik-Stoker), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Chen).

PMID: 39029449
DOI: 10.5435/JAAOS-D-23-01117

Abstract

Introduction: There is a paucity of research comparing postoperative complication rates between manual total knee arthroplasty (M-TKA) and robotic-assisted total knee arthroplasty (RA-TKA). This study aims to compare 90-day postoperative complication, readmission, and emergency department rates between RA-TKA and M-TKA.

Methods: A retrospective review of a multihospital database identified patients who underwent TKA between January 2016 and May 2023. Surgeons who used the robotic-assisted surgery technique in <10% or >90% of their cases annually were excluded. This resulted in 15,999 cases (8,853 RA-TKAs; 7,146 M-TKAs) from 282 surgeons. RA-TKA and M-TKA cohorts were one-to-one matched based on patient sex, age, body mass index, hospital setting, surgeon experience, primary payer, and anesthesia type. Each cohort consisted of 7,146 patients (N = 14,292). 90-day revisits, specifically readmissions, readmissions with >23 hours of observation, and ED visit rates were compared between cohorts. Complications were classified according to the Clinical Classification Software schema and compared between cohorts. Mann-Whitney U, chi-squared, and Fisher exact tests, along with Bonferroni correction, were used to statistically compare cohorts.

Results: All-cause 90-day readmission rates were 2.4% for RA-TKA and 2.6% for M-TKA (P = 0.36). RA-TKA had fewer revisits (RA-TKA: 7.8%; M-TKA: 8.8%, P = 0.027) and rates of readmission with >23 hours of observation (RA-TKA: 1.4%; M-TKA: 2.0%, P = 0.003). RA-TKA had fewer hospital revisits due to joint stiffness (RA-TKA: 17 revisits; M-TKA: 42 revisits, P = 0.002) and chronic pain (RA-TKA: 1 revisit; M-TKA: 8 revisits, P = 0.039). Fewer readmissions were observed for acute injuries (lower extremity muscle/tendon strains) in the RA-TKA cohort (RA-TKA: 1; M-TKA: 9, P = 0.021). RA-TKA had fewer ED visits due to hematomas (RA-TKA: 0 visits; M-TKA: 7 visits, P = 0.016).

Conclusion: In this retrospective matched cohort analysis, RA-TKA was associated with markedly fewer revisits and readmissions with >23 hours of observation compared with M-TKA. No differences in all-cause 90-day readmission were observed between cohorts.

Level of evidence: Level III.

Study design: Retrospective review.