Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis

OBJECTIVE: We conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020. ELIGIBILITY CRITERIA: Case–control studies comparing robotic-assisted and conventional UKA. DATA EXTRACTION AND SYNTHESIS: Data from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ(2) and I(2) tests. All analyses were performed using the ‘metafor’ package of R V.3.6.2 software. RESULTS: A total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis. CONCLUSIONS: This study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required. PROSPERO REGISTRATION NUMBER: CRD42021246927.