Mid-to long-term complications and revision rates of robotic-assisted unicompartmental knee arthroplasty: a systematic review and meta-analysis

Desheng Xie¹Xiaolin Chen¹Jianming Huang¹Zheyuan Huang¹Weizong Weng¹Danlei Huang¹Bowen Wang¹Ying Zhang^2*

• ¹Xiamen University Affiliated Chenggong Hospital, fujian, China
• ²Department of Orthopedic Surgery, The 920th Hospital of Joint Logistics Support Force, Kunming, China

Objective: Unicompartmental knee arthroplasty (UKA) is a commonly performed procedure for patients with isolated osteoarthritis (OA). In recent years, robotic-assisted UKA (RAUKA) has raised concerns regarding its revision rates and risk of complications. This study aims to compare the mid-to long-term complications and revision rates between RAUKA and traditional UKA, providing evidence to support its clinical application. Methods: In accordance with PRISMA guidelines, we conducted a systematic review of studies comparing complication and revision rates between RAUKA and traditional UKA, with a minimum average follow-up duration of three years. Comprehensive searches were conducted in PubMed, Embase, Web of Science, and Cochrane databases, with a cutoff date of October 1, 2024. The outcome measures analyzed included complications, revision rate, postoperative aseptic loosening, fractures, malalignment, pain, and OA. Results: Six studies were included, encompassing 48,091 knee cases, with follow-up durations ranging from 36 to 106.4 months. RAUKA significantly reduced the overall complication rate (odds ratio: 0.27, 95% CI: 0.11-0.63, P = 0.003) and revision rate (odds ratio: 0.28, 95% CI: 0.12-0.67, P = 0.004) compared to traditional UKA. RAUKA also significantly reduced the incidence of postoperative aseptic loosening (odds ratio: 0.29, 95% CI: 0.17-0.50, P < 0.001) and fractures (odds ratio: 0.20, 95% CI: 0.05-0.79, P = 0.020). However, no significant differences were found between the two groups for postoperative malalignment, pain, or secondary OA. Conclusions: This study is the first to include mid-to long-term follow-up (≥3 years) data comparing RAUKA and traditional UKA. The findings indicate that RAUKA outperforms traditional UKA in terms of overall complication and revision rates, with a lower incidence of key complications such as postoperative aseptic loosening and fractures. RAUKA appears to be a safer surgical option for OA patients, supporting its broader clinical application. However, further long-term, multicenter studies are needed to fully validate its efficacy and long-term safety.