INTRODUCTION: Robotic-arm-assisted unicompartmental knee arthroplasty (rUKA) has grown in popularity, but the spectrum of complications associated with any one platform remains incompletely characterized. This systematic review and meta-analysis evaluated the intraoperative, perioperative, and postoperative complication profile of a single computed tomography (CT)-guided, semi-active robotic platform and compared this against contemporary manual (mUKA) cohorts.
METHODS: PubMed, Embase, and Cochrane Library were searched for Level II to IV studies published since 2005 on complications associated with the rUKA system. Quality assessment was performed using a risk of bias assessment tool. The meta-analysis component pooled comparative non-registry studies as the primary analysis, evaluating complications of rUKA versus mUKA. A total of 35 articles, totalling 10,894 rUKA and 10,065 mUKA cases was included. There were 21 intraoperative, nine postoperative medical, and 432 postoperative surgical complications that were reported for rUKA. The intraoperative complication incidence was 0.2%, including pin-related fractures, soft-tissue injuries, and mechanical system errors. Overall complications totaled 4.2% for rUKA and 5.5% for mUKA.
RESULTS: Meta-analysis of comparative studies demonstrated fewer overall complications occurring in rUKA (3.8 versus 5.5%; odds ratio (OR) 0.67, 95% confidence interval (CI) 0.55 to 0.82; P < 0.01), but no statistically significant difference for deep periprosthetic joint infection (OR 0.41, 95% CI 0.06 to 2.62; P = 0.34), additional procedures (OR 0.71, 95% CI 0.26 to 1.92; P = 0.49) or prosthetic loosening (OR 1.29, 95% CI 0.23 to 7.23; P = 0.77). Sensitivity analyses including registry studies demonstrated a statistically significant reduction in additional procedures favoring rUKA (OR 0.53, 95% CI 0.39 to 0.71; P < 0.01), though this was driven predominantly by one registry study.
CONCLUSIONS: The CT-guided rUKA demonstrated a low cumulative complication incidence and comparable safety to contemporary mUKA across pooled outcomes. Although differences did not reach statistical significance in the primary non-registry analyses, trends consistently favored rUKA. These findings help further characterize the safety profile of this robotic platform and support the need for platform-specific complication reporting and longer-term comparative data.
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