Robotic arm-assisted versus manual unicompartmental knee arthroplasty A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE MAKO ROBOTIC SYSTEM

Aims This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA). Methods Searches of PubMed, MEDUNE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included robotic, unicompartmental, knee, and arthroplasty. Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis. Results A total of 179 articles were identified from initial screening, of which 14 articles satisfied the inclusion criteria and were included for analysis. The papers analyzed include one on learning curve, five on implant positioning, six on functional outcomes, five on complications, six on survivorship, and three on cost. The learning curve was six cases for operating time and zero for precision. There was consistent evidence of more precise implant positioning with MAKO RAUKA. Meta-analysis demonstrated lower overall complication rates associated with MAKO RAUKA (OR 2.18 (95% confidence interval (CI) 1.06 to 4.49); p = 0.040) but no difference in reintervention, infection, Knee Society Score (KSS; mean difference 1.64 (95% CI -3.00 to 6.27); p = 0.490), or Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (mean difference -0.58 (95% CI -3.55 to 2.38); p = 0.700). MAKO RAUKA was shown to be a costeffective procedure, but this was directly related to volume. Conclusion MAKO RAUKA was associated with improved precision of component positioning but was not associated with improved PROMs using the KSS and WOMAC scores. Future longer-term studies should report functional outcomes, potentially using scores with minimal ceiling effects and survival to assess whether the improved precision of MAKO RAUKA results in better outcomes.

Automated summary

This systematic review compares the precision of component positioning, patient-reported outcome measures, complications, survivorship, cost-effectiveness, and learning curves between MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) and manual medial unicompartmental knee arthroplasty (mUKA). The review found that MAKO RAUKA has better precision in implant positioning, but no improvement in patient-reported outcome measures. In addition, MAKO RAUKA is shown to be cost-effective, but this is related to the volume of surgeries.