- Design
- Target trial emulation using national registry data, propensity matched
- Population
- 697 145 knee replacements in the UK registry, 2018–2024
- Primary outcome
- Five-year implant survival (revision for any cause)
- Effect
- TKR: 98.6% robotic vs 98.5% conventional; HR 1.03 (0.86–1.26)
Using the National Joint Registry for England, Wales, Northern Ireland and the islands, researchers emulated a target trial comparing 22 111 robotic with 675 034 conventional knee replacements carried out from 2018 to 2024, matched on propensity score.
Five-year implant survival for total knee replacement was 98.5% conventional and 98.6% robotic (HR for revision 1.03, 95% CI 0.86–1.26). For unicompartmental replacement it was 97.8% and 96.4% (HR 1.03, 0.75–1.42). Cause-specific revision and intraoperative complications did not differ.
Mean follow-up was only 2.5 years, and the design cannot exclude unmeasured confounding. But with higher capital and per-case costs, robotic surgery has not yet shown the implant-survival advantage that would justify them on these outcomes. Patient-reported function was not assessed here.
- When patients ask whether a robotic knee lasts longer, early registry data show no difference in revision.
- Choice of surgeon and hospital volume remain more established factors in outcome than the tool used.
- Function and pain outcomes were not reported in this analysis.
- Longer follow-up is needed before drawing conclusions on late revision.
Why it matters
Robotic surgery is being marketed to patients ahead of evidence that it lasts longer.
Don't overread it
This is observational with short follow-up; it does not show robotic surgery is no better for function or late survival.
The statistics, in plain English
A hazard ratio of 1.03 with an interval from 0.86 to 1.26 means the data fit anything from a 14% lower to a 26% higher revision rate with robotic surgery — no clear difference either way.
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