Robotic-assisted total knee arthroplasty associated with lower odds of vascular injury: A retrospective cohort analysis.

BACKGROUND

Vascular injury during total knee arthroplasty (TKA) is rare, but potentially catastrophic, leading to ischemia, the need for vascular repair, or limb loss. Robotic-assisted TKA (RA-TKA) incorporates computed tomography (CT)-based three-dimensional planning, intraoperative balancing, and haptic boundaries that may reduce intraoperative saw excursion and mitigate neurovascular risk. This study compared the incidence of vascular injuries between RA-TKA and conventional manual TKA (M-TKA).

METHODS

A retrospective query of a nationwide insurance claims database (2010 to 2022) identified 2,522,651 primary TKAs (21,921 RA-TKA; 2,500,730 M-TKA). The RA-TKA was defined by robotic-assisted procedure codes and CT scan within 60 days of surgery. Vascular injuries within 30 days of surgery were identified using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis and procedure codes. A 1:5 nearest-neighbor matching algorithm controlled for age, sex, and comorbidities. Before matching, RA-TKA patients differed in age, sex, and comorbidity profiles compared with M-TKA. After matching, the cohorts were well-balanced. Multivariable logistic regressions calculated odds ratios (OR) with 95% confidence intervals (CI) for vascular complications, with significance set at P < 0.05.

RESULTS

Popliteal artery injuries occurred in 49 M-TKA (0.002%) and zero RA-TKA (0%) cases. After adjustment, RA-TKA was associated with significantly lower odds of vascular injury compared with M-TKA (adjusted OR 0.21, 95% CI 0.05 to 0.86, P = 0.030). The absolute risk difference was 0.002%, corresponding to a number needed to treat of 50,000.

CONCLUSIONS

In this large national cohort, RA-TKA was associated with a substantially reduced risk of popliteal artery injury compared with M-TKA. While rare overall, the catastrophic consequences of vascular injury underscore the clinical importance of this association. As TKA utilization rises, robotic platforms may offer a meaningful clinical benefit by helping surgeons reduce the incidence of these devastating neurovascular complications.