BACKGROUND Robotic-assisted TKA continues to see wider clinical use, despite limited knowledge of its impact on patient satisfaction and implant survival. Most studies to date have presented small cohorts and came from single-surgeon or single-center experiences. Therefore, a population-level comparison of revision rates between robotic-assisted and conventional TKA in the registry setting may help arthroplasty surgeons better define whether robotic assistance provides a meaningful advantage compared with the conventional technique. QUESTIONS/PURPOSES (1) After controlling for confounding variables, such as surgeon, location of surgery, and patient comorbidity profile, were robotic-assisted TKAs less likely than conventional TKAs to result in revision for any reason at 2 years? (2) After again controlling for confounding variables, were robotic-assisted TKAs less likely to result in any specific reasons for revision than the conventional technique at 2 years? METHODS The American Joint Replacement Registry was used to identify patients 65 years or older who underwent TKA between January 2017 and March 2020 with a minimum of 2 years of follow-up. Patients were limited to age 65 yeas or older to link TKAs to Medicare claims data. Two retrospective cohorts were created: robotic-assisted TKA and conventional TKA. Patient demographic variables included in the analysis were age, gender, BMI, and race. Additional characteristics included the Charlson comorbidity index, anesthesia type, year of the index procedure, and length of stay. A total of 10% (14,216 of 142,550) of TKAs performed during this study period used robotics. Patients with robotic-assisted TKA and those with conventional TKA were similar regarding age (73 ± 6 years versus 73 ± 6 years; p = 0.31) and gender (62% [8736 of 14,126] versus 62% [79,399 of 128,334] women; p = 0.34). A multivariable, mixed-effects logistic regression model was created to analyze the odds of all-cause revision as a factor of robot use, and a logistic regression model was created to investigate specific revision diagnoses. RESULTS After controlling for potentially confounding variables, such as surgeon, location of surgery, and Charlson comorbidity index, we found no difference between the robotic-assisted and conventional TKAs in terms of the odds of revision at 2 years (OR of robotic-assisted versus conventional TKA 1.0 [95% CI 0.8 to 1.3]; p = 0.92). The reasons for revision of robotic-assisted TKA did not differ from those of conventional TKA, except for an increased odds of instability (OR 1.6 [95% CI 1.0 to 2.4]; p = 0.04) and pain (OR 2.1 [95% CI 1.4 to 3.0]; p < 0.001) in the robotic-assisted cohort. CONCLUSION In light of these findings, surgeons should not assume that robotic assistance in TKA will lead to improved early implant survival. Our findings do not support an improvement over conventional TKA with robotic assistance with regards to common causes of early revisions such malalignment, malposition, stiffness, pain, and instability, and in some cases, suggest there is a benefit to conventional TKA. Differences in the mid-term and long-term revision risk with conventional versus robotic-assisted TKA remain unknown. Appropriate informed consent around the use of robotic assistance should not imply decreased early revision risk. LEVEL OF EVIDENCE Level III, therapeutic study.

中文翻译：

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机器人辅助 TKA 与早期翻修几率降低无关：对美国关节置换登记处的分析。

背景技术尽管人们对其对患者满意度和种植体存活率的影响了解有限，但机器人辅助全膝关节置换术继续在临床上得到更广泛的应用。迄今为止，大多数研究都是小规模的研究，并且来自单外科医生或单中心的经验。因此，在注册机构中对机器人辅助和传统 TKA 的翻修率进行人群水平的比较可能有助于关节置换术外科医生更好地确定机​​器人辅助与传统技术相比是否具有有意义的优势。问题/目的 (1) 在控制了混杂变量（例如外科医生、手术地点和患者合并症概况）后，机器人辅助 TKA 是否比传统 TKA 更不可能在 2 年后因任何原因导致翻修？(2) 再次控制混杂变量后，2 年时机器人辅助 TKA 是否比传统技术更不可能导致任何特定原因的翻修？方法 美国关节置换登记处用于识别 2017 年 1 月至 2020 年 3 月期间接受 TKA 且至少随访 2 年的 65 岁或以上患者。将 TKA 与医疗保险索赔数据关联起来的患者年龄仅限于 65 岁或以上。创建了两个回顾性队列：机器人辅助 TKA 和传统 TKA。分析中包括的患者人口统计变量包括年龄、性别、体重指数和种族。其他特征包括查尔森合并症指数、麻醉类型、指数手术年份和住院时间。在本研究期间，共有 10%（142,550 例中的​​ 14,216 例）使用机器人技术进行了 TKA。接受机器人辅助 TKA 的患者与接受传统 TKA 的患者在年龄（73 ± 6 岁 vs 73 ± 6 岁；p = 0.31）和性别（62% [14,126 中的 8736] 例）与 62%（128,334 例中的 79,399 例）女性相似； p = 0.34）。创建了一个多变量、混合效应逻辑回归模型来分析全因翻修作为机器人使用因素的可能性，并创建了一个逻辑回归模型来研究特定的翻修诊断。结果 在控制了潜在的混杂变量（例如外科医生、手术地点和 Charlson 合并症指数）后，我们发现机器人辅助和传统 TKA 在 2 年翻修几率方面没有差异（机器人辅助与传统 TKA 的 OR 值）传统 TKA 1.0 [95% CI 0.8 至 1.3]；p = 0.92）。机器人辅助 TKA 翻修的原因与传统 TKA 没有什么不同，除了不稳定的可能性增加（OR 1.6 [95% CI 1.0 至 2.4]；p = 0.04）和疼痛（OR 2.1 [95% CI 1.4 至 3.0]；p < 0.001）在机器人辅助队列中。结论 鉴于这些发现，外科医生不应认为全膝关节置换术中的机器人辅助会提高早期种植体的存活率。我们的研究结果不支持在机器人辅助下对传统全膝关节置换术进行改进，以解决早期翻修的常见原因，例如排列不齐、错位、僵硬、疼痛和不稳定，在某些情况下，表明传统全膝关节置换术有好处。传统 TKA 与机器人辅助 TKA 的中期和长期翻修风险的差异仍然未知。关于使用机器人辅助的适当知情同意不应意味着早期翻修风险的降低。证据级别 III 级，治疗研究。