SynthesisJournal of robotic surgery2026
Periprosthetic fractures associated with pin placement in robot- or navigation-assisted total knee arthroplasty: a systematic review and meta-analysis.
Synthesis in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Robotic-assisted total knee arthroplasty: accuracy, clinical outcomes, complications, learning curve and cost-effectiveness: a critical clinical review.Journal of robotic surgery · 2026Review
- Pooling robotic and navigation-assisted systems, bone mineral density omission, and platform-specific pin geometry: critical concerns in the meta-analysis of periprosthetic fractures after tracker pin placement in total knee arthroplasty.Journal of robotic surgery · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The adoption of robotic and computer navigation technologies in total knee arthroplasty (TKA) has expanded rapidly, introducing new device-related complications. Among these, fractures occurring at tracker pin insertion sites have raised increasing clinical concern. This systematic review and meta-analysis evaluated the incidence, observed associations, and clinical outcomes of periprosthetic fractures associated with pin placement in robotic- and navigation-assisted TKA. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261325067). Studies involving adult patients undergoing primary robotic- or navigation-assisted TKA that reported periprosthetic fractures attributable to tracker pin sites were included. Extracted data encompassed study design, navigation or robotic platform, pin configuration, fracture characteristics, and clinical outcomes. A random-effects meta-analysis was performed to estimate the pooled fracture incidence and its 95% confidence interval (CI). Prespecified subgroup analyses examined the influence of pin diameter, cortical engagement, and anatomical pin location. Results: Seventeen studies encompassing 13,217 robotic- or navigation-assisted TKA procedures met the inclusion criteria. The pooled incidence of pin-related periprosthetic fracture was 0.11% (95% CI, 0.06–0.21%), with moderate heterogeneity (I² = 48%). Increased fracture risk was consistently observed with diaphyseal pin positioning and bicortical fixation compared with metaphyseal or unicortical placement. Additional observed associations included larger pin diameters (≥ 4 mm) and multiple drilling attempts. No evidence of significant publication bias was identified. In reported cases, fracture management led to successful union and satisfactory functional recovery. Conclusions: Tracker pin–associated periprosthetic fractures are uncommon but clinically meaningful complications of robotic and navigation-assisted TKA. Risk mitigation strategies may include placing metaphyseal unicortical pins, minimizing drilling attempts, and selecting smaller-diameter pins. Heightened caution is warranted in patients with compromised bone quality or elevated body mass index.
Indexed as
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.