AI-assisted Preoperative Planning Combined with Robotic-assisted Total Knee Arthroplasty vs. Conventional Surgery: A Retrospective Controlled Study

Objective: To compare perioperative outcomes and early functional recovery between AI-robotic and conventional total knee arthroplasty (TKA). Methods: We retrospectively analyzed data from 88 patients who underwent primary unilateral TKA for knee osteoarthritis between April 2024 and December 2024. The AI-robotic group (n=44) received AI-assisted preoperative planning and robot-assisted TKA, while the traditional group (n=44) underwent conventional 2D templating and manual TKA. Key metrics included preoperative prosthesis prediction accuracy, intraoperative and postoperative blood loss, osteotomy time, postoperative radiographic alignment, and functional scores. Results: The AI-robotic group showed significantly higher prosthesis prediction accuracy (femoral: 79.5% vs. 52.3%, P =0.023; tibial: 84.1% vs. 61.4%, P =0.042), shorter osteotomy time (15.24±4.71 vs. 18.43±4.76 minutes, P =0.002), reduced intraoperative blood loss (197.41±78.41 vs. 234.35±74.53 mL, P =0.026), and lower 72-hour total blood loss (1022.96±226.14 vs. 1118.71±193.30 mL, P =0.036). Postoperative lateral femoral component (LFC) angles were superior in the AI-robotic group (5.87±2.18° vs. 6.91±2.10°, P =0.025). At 6 weeks, the AI-robotic group had better VAS pain scores (2.27±1.12 vs. 2.84±1.22, P =0.029) and HSS scores (61.57±4.40 vs. 59.59±3.80, P =0.027). Conclusion: AI-assisted preoperative planning with robotic TKA improves prosthesis sizing accuracy, reduces perioperative blood loss and 72h total blood loss, and enhances early functional outcomes compared to conventional methods. These findings support AI-robotic integration as a precision solution for TKA, particularly in complex cases.