Functional alignment robotic‐assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single‐surgeon randomised controlled non‐inferiority trial with 2‐year follow‐up

This single-center RCT randomized 180 patients undergoing primary TKA to either robotic-assisted total knee arthroplasty using a functional-alignment (kinematic-based) technique (FA-RATKA) or conventional mechanically-aligned TKA (MA-CTKA), following them for 2 years with a battery of knee scores. FA-RATKA showed statistically significant but small improvements over time in several patient-reported outcomes, including KSS Function (p<0.001, r=0.173), KSS Satisfaction (p<0.001, r=0.214), KSS Symptoms (p=0.004, r=0.138), Oxford Knee Score (p<0.001, r=0.185), VAS pain (p<0.001, r=0.188) and EQ-5D index (p=0.006, r=0.141), while other measures (KSS Expectations, LEAS, FJS-12, EQ-5D VAS) showed no difference. No revisions, deep infections or periprosthetic fractures occurred in either group by 2 years.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersThis adds single-surgeon RCT data to the ongoing debate about whether robotic functional alignment TKA meaningfully improves patient-reported outcomes over conventional mechanically-aligned TKA, a question directly relevant to whether surgeons should adopt costly robotic platforms.

Presenting this at rounds? Start here

• ?If the observed differences (effect sizes r=0.12-0.21) are statistically significant but below typical MCID thresholds for KSS and OKS, should surgeons change their alignment philosophy based on these results alone?
• ?Given that a larger, multicenter, blinded RASKAL trial found no differences between functional and mechanical alignment, how should a surgeon weigh a single high-volume operator's favorable results against that contrasting multicenter evidence when counseling patients about robotic TKA?