Robotic Assistance for Low-Volume Total Knee Arthroplasty Surgeons Is Associated With Comparable Perioperative Outcomes Related to Those of High-Volume Surgeons Using Conventional Techniques

Background Studies have reported mixed utility of robotics in total knee arthroplasty (TKA). Separately, higher surgical volume has correlated with improved outcomes. The potential interplay of these variables has not been assessed. Methods Patients undergoing conventional and robotic TKAs performed by low-volume and high-volume surgeons were identified from PearlDiver M170Ortho. Three matched comparisons were performed: conventional low-volume TKA (LV-TKA) vs robotic LV-TKA (R-LV-TKA), conventional high-volume TKA (C-HV-TKA) vs robotic high-volume TKA (R-HV-TKA), and C-HV-TKA vs R-LV-TKA. Aggregated 90-day adverse events (AEs), 5-year implant-related events, and revision rates were assessed. Results Among low-volume surgeons, there were 8923 conventional LV-TKAs and 2235 R-LV-TKAs. R-LV-TKAs had lower odds of 90-day any (odds ratio [OR] 0.63), severe (OR 0.71), and minor (OR 0.66) AEs, driven by deep vein thrombosis (OR 0.47) and transfusion (OR 0.43) rates (all P < .003). At 5 years, no differences existed in implant-related events or revisions. Among high-volume surgeons, there were 19,732 C-HV-TKAs and 4939 R-HV-TKAs. R-HV-TKAs had lower odds of 90-day any (OR 0.79) and minor (OR 0.74) AEs, driven by urinary tract infection (OR 0.63) and transfusion (OR 0.45) rates (all P < .001). At 5 years, R-HV-TKAs had lower odds of periprosthetic joint infection (OR 0.56, P < .001) and revision rates (2.2% vs 3.3%, P = .02). Comparing C-HV-TKAs and R-LV-TKAs, no differences existed in 90-day AEs, 5-year implant-related events, or revisions. Conclusions Robotic assistance was associated with lower odds of aggregated perioperative complications for low-volume and high-volume surgeons and with improved 5-year outcomes in high-volume robotic surgeons. Notably, robotic usage by low-volume surgeons was associated with outcomes comparable to nonrobotic high-volume surgeons, suggesting outcome gaps because of volume may be partially closed through robotics.