Enterprise AI Analysis

Stem anteversion is not affected by proximal femur geometry in robotic-assisted total hip arthroplasty

This Italian study investigated the impact of proximal femoral geometry on THA stem position using the Stryker Mako® system and 'enhanced' workflow. In 102 patients undergoing THA with an Accolade® II stem, the mean native FNV was 6.6°, and final stem version was 16.4°. The study suggests aligning the stem to native femoral anteversion 10mm above the lesser trochanter reliably achieved target version (5°-25°) in 96.1% of cases, indicating robotic assistance helps achieve optimal anteversion regardless of complex femoral geometry.

Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty

This collaborative study retrospectively compared post-operative narcotic consumption in patients undergoing primary THA with robotic-assistance versus conventional methods. Using an anterior approach and ROSA® Total Hip System, 211 patients were analyzed. Findings showed significant reductions in post-operative analgesic consumption (MMEs) with robotic-assisted technique, highlighting its value for rapid recovery pathways and optimized pain control. The exact mechanism for reduced pain still needs further elucidation.

Metric	Robotic-Assisted THA	Manual THA
Narcotic Consumption (MMEs)	Significant reductions post-operatively	Higher consumption rates
Early Pain Control	Optimized for rapid recovery pathways	Less optimized for early pain management
Recovery Pathways	Supports rapid recovery / short-stay arthroplasty	May have longer recovery times due to pain

Reliability of pre-resection ligament tension assessment in imageless robotic assisted total knee replacement

This Chinese prospective study aimed to quantify the reliability of pre-resection ligament tension assessment using an imageless, robot-assisted TKA approach (CORI TKR system). In a small cohort of 24 knees, the study found good-to-excellent intra- and inter-rater reliability for assessing knee tension in all positions, except 'flexion lateral'. More senior surgeons consistently produced larger gaps during knee balance. This work needs replication with other systems.

No evidence of mid-flexion instability after robotic-assisted total knee arthroplasty as assessed by intraoperative pressure sensors

This Australian study investigated mid-flexion instability after uncomplicated TKA using intra-operative pressure sensors (Verasense) combined with the Mako® robotic system. In 72 knees, no significant pressure difference (above 15 pounds) was found in the medial compartment, and no patient showed a pressure difference exceeding 15 pounds at 45° across both compartments. The authors concluded no clinical or statistical evidence of mid-flexion instability with Mako®-assisted primary TKAs using a single-radius, cruciate-retaining prosthesis.

Assessment Point	Medial Compartment	Lateral Compartment
10° Flexion Pressure	No significant difference	Statistically higher pressures (P<0.001)
45° Flexion Pressure	No significant difference	Statistically higher pressures (P<0.001)
90° Flexion Pressure	No significant difference	Statistically higher pressures (P<0.001)
Overall Instability (at 45°)	No patient showed >15lb difference	No patient showed >15lb difference

Robotic-assisted differential total knee arthroplasty with patient-specific implants: surgical techniques and preliminary results

This study reports kinematic evaluation and early clinical outcomes of TKAs performed using patient-customized iTotal CR TKA (Conformis) with TiRobot Recon Robot (TINAVI). The novel combination allows enhanced intra-operative assessment (gap quantification, force determination, live femoral-tibial tracking). In 17 knees, the system achieved 'excellent' intra-operative joint kinematics and acceptable radiographic/clinical outcomes. The authors propose it leads to improved functional and patient satisfaction, particularly for diverse knee morphotypes.

Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation

This multicenter study assessed immediate post-operative range-of-movement (ROM) gains in 216 robot-assisted TKAs (ROSA® system) vs. 216 propensity-matched manual TKAs. Robotic TKA patients showed significant improvements in ROM at one and three months (mean 6.9° and 4.9° degrees better) and a higher odds ratio (2.15) of achieving 90° flexion at one month. The authors conclude robotic TKA enables faster active ROM recovery, emphasizing change in ROM as a key metric for patient satisfaction.

Metric	Robotic-Assisted TKA	Manual TKA
ROM at 1 Month	Significantly improved (mean 6.9° better)	Lesser ROM gains
ROM at 3 Months	Significantly improved (mean 4.9° better)	Lesser ROM gains
Achieving 90° Flexion (1 Month)	Higher odds ratio (2.15)	Lower odds of achieving
Recovery Speed	Faster recovery of active ROM	Slower active ROM recovery

Robotic-assisted revision total knee arthroplasty: a novel surgical technique

This Australian paper describes the early follow-up (up to 18 months) of 19 patients undergoing robotic-assisted revision TKA (Stryker Mako® system). It outlines pre-, peri-, and post-operative considerations, addressing challenges like in situ metalwork and bone stock preservation. The authors provide insight into future extensions of robotic technologies for revision surgery, noting the need for software modifications and improved image acquisition techniques for these complex cases.

Application of machine learning in the prevention of periprosthetic joint infection following total knee arthroplasty: a systematic review

This PRISMA review assessed AI applications, specifically machine learning (ML), in preventing periprosthetic joint infection (PJI) after TKA. Identifying 11 studies of 'fair' methodologic quality, the review categorized applications into PJI prediction, diagnosis, antibiotic application, and prognosis. It suggests ML-based approaches hold value but cautions for more research to validate widespread uptake, highlighting convincing AUC data and the potential of AI-informed datasets for improving benchmark standards-of-care.

Application Area	ML Strengths	Validation Needs
PJI Prediction	Ability to identify high-risk patients early	Further research for widespread uptake
Diagnosis	Potential for consistent and reproducible diagnostic pathways	More robust evidence from diverse settings
Antibiotic Application	Optimized dosing and timing based on patient data	Clinical trials for efficacy and safety
Prognosis	Predicting long-term outcomes and recurrence risk	Longitudinal studies with large cohorts

A role for artificial intelligence applications inside and outside of the operating theatre: a review of contemporary use associated with total knee arthroplasty

This meta-synthetic review examines AI applications in TKA surgery across pre-, intra-, and post-operative phases. It highlights current AI strengths in mass data handling, outcome prediction, and administrative tasks, offering time and cost savings. While acknowledging promising AI technologies, it cautions that some have failed to surpass human-driven standards, emphasizing the need for evidence-based validation to keep pace with the rapidly growing hype and ensure generalizable, reproducible applications.