Robotic-assisted total knee arthroplasty with MAKO is associated with improved functional outcomes : a systematic review and meta-analysis.

Aims: To improve functional outcomes following total knee arthroplasty (TKA), robotic systems have been introduced such as the MAKO (Stryker), the most widely used system globally at present. This systematic review aimed to compare the patient-reported outcome measures (PROMs) of robotic TKA (RTKA) to manual TKA (MTKA). Methods: Five electronic databases were systematically searched for eligible articles that used PROMs to compare MAKO RTKA to MTKA. The primary outcome was the Forgotten Joint Score (FJS). We defined follow-up periods as short (up to three months), medium (three months to one year), and long term (beyond one year). We pooled outcomes combining the Knee Society Scoring System (KSS), Oxford Knee Score (OKS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Meta-analyses were conducted using a random-effects model and reported using mean difference (MD) or standardized mean difference (SMD) and 95% CI. Results: In total, 22 articles evaluating 3,738 TKAs were included: 1,835 MTKAs and 1,903 RTKAs. The evidence level for most studies were IIa, due to few high-level studies. Using FJS, meta-analysis showed little difference at short-term follow-up (MD 11.49, 95% CI -5.62 to 28.59), but found a difference at medium-term follow-up (MD 5.50, 95% CI 2.19 to 8.81). This was not sustained at long-term follow-up (MD 23.89, 95% CI -16.50 to 64.27). Pooling all PROMs showed no difference in the short term (SMD 0.27, 95% CI -0.05 to 0.59), but results favoured RTKA at medium- (SMD 0.46, 95% CI 0.22 to 0.70) and long-term follow-up (SMD 0.40, 95% CI 0.13 to 0.66). Conclusion: There are few high-level studies, but based on current data MAKO RTKA may result in improved functional outcomes compared to MTKA. Further randomized controlled trials are required to provide robust data and to assess clinical and cost-effectiveness as well as a wider spectrum of early and late outcomes.