Robotic-assisted total knee arthroplasty leads to a higher proportion of better Kujala score and global patient-reported outcomes measurements compared to conventional surgery after a minimum of two years of follow-up
Bibliographic record
Abstract
INTRODUCTION: Total knee arthroplasty (TKA) is a widely adopted surgical intervention for individuals with severe knee osteoarthritis. The integration of robotic assistance in TKA (R-TKA) has been proposed to enhance surgical precision and patient outcomes. Specifically, R-TKA has demonstrated enhanced consistency in radiological outcomes. However, consistent improvements in clinical results remains to be proven, as existing reports are heterogeneous, necessitating further investigation. This study compares patient-reported outcome measurements (PROMs) for TKA performed with conventional (C-TKA) versus R-TKA. Specifically, it evaluates the frequency of patients achieving Patient Acceptable Symptom State (PASS), Threshold for Improved Satisfaction (TIS), and Threshold for Improved Failure (TIF) for Western Ontario and McMaster Universities Arthritis Index (WOMAC), Kujala, and Knee Injury and Osteoarthritis Outcome Score quality of life (KOOS-QoL) questionnaires. METHODS: A retrospective analysis was conducted using institutional data from 2016 to 2021, involving 149 TKA cases (41 R-TKA, 108 C-TKA) with a minimum follow-up of two years. Patients completed validated PROMs, including WOMAC, Kujala, and KOOS-QoL. Propensity score matching adjusted for variables including age, sex, surgeon, side, and patellar resurfacing. The primary outcome was the proportion of patients surpassing PASS and TIS thresholds for WOMAC pain, WOMAC function, Kujala and KOOS-QoL. RESULTS: A total of 117 patients were contacted. Patients who underwent R-TKA showed a significantly higher proportion of favorable outcomes compared to those with C-TKA. Specifically, 30% more patients in the R-TKA group surpassed the Kujala threshold (95% CI: 18%-45%; 1-β = 0.97), and 29% more met all thresholds simultaneously, indicating a successful TKA (95% CI: 13%-45%; 1-β = 0.84); both were associated with moderate to large effect sizes. Although differences in PASS achievement for WOMAC pain (+5%), WOMAC function (+6%), and KOOS-QoL favored R-TKA and reached statistical significance, the study lacked sufficient statistical power to confirm these findings with high confidence. CONCLUSIONS: Compared to C-TKA, R-TKA achieves a significantly higher proportion of patients with Kujala scores of 70 or above, as well as a higher proportion of patients meeting all targeted PROM thresholds at the two-year follow-up. These findings underscore the potential for R-TKA to optimize outcomes. LEVEL OF EVIDENCE: Clinical study, Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".