Robotic-Assisted Total Knee Arthroplasty Does Not Increase Procedure Duration or Adverse Event Incidence: A Retrospective Comparative Cohort Study in a Public Hospital.

Background Total knee arthroplasty (TKA) with various guidance methods for bone cuts and soft-tissue balancing yield excellent outcomes for end-stage knee osteoarthritis, offering durable pain relief and functional restoration. However, there is a growing interest in further enhancing intraoperative accuracy and consistency, with the aim of reducing complications and reducing recovery times through the introduction of robotic-assisted surgery (RAS). As with any new technology, concerns remain regarding the surgeon learning curve, operative efficiency, and safety profile of RAS compared to conventional techniques. This study evaluates the clinical utility of a RAS system (ROSA, Zimmer Biomet) in a public hospital setting, assessing its impact on procedure duration and adverse event incidence at 90 days postoperatively. Methods A retrospective cohort study was conducted at a mid-sized metropolitan public hospital in Brisbane, Australia. Data were extracted from a departmental registry (SHARKS), electronic medical records, and intraoperative reports from September 2017 to February 2023. The study included 568 TKA cases: 173 instrumented or navigated TKAs performed before RAS introduction (Pre-RAS), 258 robotic-assisted TKAs after RAS adoption (RAS group), and 139 TKAs performed by other department surgeons who did not use RAS (non-RAS), serving as a benchmark for department-wide outcomes. The primary outcomes were procedure duration and adverse event incidence including surgical site infection (SSI), venous thromboembolism (VTE), knee stiffness, and all-cause readmission within 90 days postoperatively. Results The pre-RAS group had significantly longer operative times than the RAS group (128 ± 21.6 min vs. 121.4 ± 19.5 min, p  < 0.01), suggesting improved efficiency with RAS adoption. The non-RAS department group had shorter procedure durations than the pre-RAS group (118.3 ± 20.1 min, p  < 0.01). Among 67 recorded adverse events, no significant differences in total adverse event incidence were observed between the pre-RAS and RAS groups (12.1% vs. 11.6%, p  = 0.78). A non-significant increase in superficial infections in males undergoing RAS-TKA was observed ( p  = 0.062). Conclusion RAS-TKA demonstrated reduced operative time and a comparative safety profile to navigated TKA. These findings suggest that RAS integration improves surgical efficiency without compromising safety, warranting further investigation into long-term functional and economic outcomes.