Technology‐assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review

Purpose: The aim of this systematic review was to evaluate the outcomesand complications associated with technology‐assisted revision total kneearthroplasty (revTKA).Methods: A systematic search of PubMed, EMBASE, Web of Science andthe Cochrane Library was conducted from inception to 31 October 2024.The inclusion criteria were experimental or observational studies with ≥10patients undergoing robotic revTKA, evaluating clinical and/or radiologicaloutcomes and/or complication rates. The exclusion criteria were isolatedpatellar revision, in vitro studies, letters to the editor, book chapters, con-ference papers, and studies without accessible full text. Each study wasgiven a quality rating using the methodological index for non‐randomisedstudies (MINORS). The included studies were divided into those reportingrevision from TKA and those from unicompartmental knee arthroplasty(UKA), for both qualitative and quantitative synthesis. Random‐effectsmeta‐analyses were performed where appropriate. Mean differences with95% confidence intervals (CIs) were calculated for radiographic parame-ters. Heterogeneity was assessed using the I2 statistic.Results: Across 20 studies (795 cases), 10 assessed revTKA and 10 ex-amined revUKA. Of the revTKA studies, four were comparative cohorts,while among the revUKA studies, seven were comparative cohorts.Technology‐assisted revTKA showed fewer outliers in hip–knee–ankleangle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]),superior component positioning within ±3° for the lateral distal femoral angle(88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and forthe medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6%[95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3%within 4 mm). Procedures required an additional 15–24 min. Complicationrates were comparable between groups. For UKA revisions, outcomes were generally similar between technology‐assisted and conventional tech-niques, with mixed results on alignment accuracy and clinical scores. Conclusion: Technology‐assisted revTKA achieves optimal alignment param-eters and reduces the occurrence of outliers compared with conventional tech-niques. However, these radiographic improvements do not consistently translateinto enhanced clinical outcomes or reduced complication rates.