ArticleMusculoskeletal surgery2026
A comparative study between two commonly used robotic systems on the accuracy of the intraoperative cuts in total knee arthroplasty.
Article in Musculoskeletal surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeWe aimed to compare the accuracy of robotic Total Knee Arthroplasty (TKA) intraoperative cuts between Computed Tomography image-based MAKO and imageless ROSA.
methodsWe retrospectively analysed registry data for patients who underwent imaged-based MAKO and imageless ROSA robotic TKA. Two reviewers independently radiographically measured the coronal alignment of the implants in relation to the mechanical axis at 3 months post-operation. These were compared to the planned intraoperative robotic cuts.
resultsOne hundred sixty-one patients underwent MAKO and 110 ROSA TKA. Intraclass correlation for radiographic readings was 0.88 to 0.96. When comparing the variability between intraoperative planned alignment and 3 months postoperative, MAKO femur showed no statistically significant difference (- 0.1° ± 0.8° vs. - 0.1° ± 1.2°, p = 0.12) and likewise no difference for tibia (- 0.9° ± 1.2° vs. - 0.6° ± 1.3°, p = 0.60). However, for ROSA, its femur showed statistically significant difference (- 1.2° ± 1.0° vs. - 0.7° ± 1.3°, p < 0.01), likewise for tibia (- 0.4° ± 0.9° vs. - 0.2° ± 1.4°, p < 0.01). The variability from intraoperation to 3 months postoperative was significantly different between MAKO and ROSA for femur (0.0° ± 1.0° vs. 0.4° ± 1.1°, p < 0.01), but was not statistically significant for tibia (0.3° ± 0.1° and 0.1° ± 1.1°, p = 0.26). There was a significant difference with a larger proportion of femur implant that deviated < 1º from intraoperative plan in MAKO compared to ROSA (62.1% and 37.2% respectively, p < 0.01). At the tibia component, there was no statistically significant difference in the proportion of the extent of deviation (p = 0.73).
conclusionThere was statistically significant variability in coronal alignment between intraoperative plan and postoperative 3 months in the imageless robotic system at both femur and tibia components. The extent of variability between the imageless and CT-image based systems in femur was also statistically significant. There was also a larger proportion of implant deviation of > 1º in the femur component in imageless robotic system. Nevertheless, the overall extent of the deviation between the intraoperative plan and the postoperative position was < 0.5º. Future studies may be performed to determine whether this would translate into any clinical significance.
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