Absence of Robotics Does Not Influence Day-of-Surgery Cancellation Rates in Total Knee Arthroplasty: Surgeon Experience and Patient Trust Mitigate Technology Expectations.

INTRODUCTION: Robotic-assisted total knee arthroplasty (rTKA) is increasingly promoted as a precision-enhancing advancement, although clinical studies consistently demonstrate comparable outcomes between rTKA and conventional TKA (cTKA). With rising patient interest in robotics, it remains unclear whether lack of robotic availability affects day-of-surgery cancellations (DOSCs). This study addresses an important knowledge gap by specifically evaluating perception-driven cancellations attributable to absence of robotics, an area that has not been previously quantified in the arthroplasty literature. MATERIALS AND METHODS: A retrospective review of all scheduled primary TKAs from January 2023 to May 2025 at two tertiary centers was conducted. Reasons for DOSCs were categorized. Only same-day cancellations (occurring on the scheduled operative day after admission or final listing) were included. Complications and Knee Society Scores (KSS) were evaluated for completed cases. RESULTS: Of 276 scheduled TKAs (Center A = 142; Center B = 134), the overall DOSC rate was 7.6% (21/276). Only 2 cancellations (0.7%) were due to absence of robotics, both from a single center. Other cancellations involved medical instability (3.26%), financial issues (1.08%), and patient withdrawal or no-show (2.2%). Outcomes of completed cTKAs were favorable: Persistent pain >6 months occurred in 2.0%, surgical-site infection in 1.6%, and mean KSS improved from 82 ± 7 at 6 weeks to 88 ± 6 at 6 months, with no major reoperations. CONCLUSION: Perception-driven cancellations due to lack of robotic systems were rare (0.7%) in this two-center audit but identifiable as a distinct behavioral pattern. Importantly, these cancellations were restricted to a single center, highlighting that counseling strategies and surgeon-patient trust - not robotic availability - shape patient adherence. Overall DOSC rates and post-operative results reaffirm the strength and resilience of cTKA, which continues to deliver reliable outcomes despite increasing marketing-driven enthusiasm for robotic surgery. These findings should be interpreted in the context of the study's limitations and do not preclude potential benefits of robotics in specific settings. LEVEL OF EVIDENCE: III (Retrospective observational study).