From Empirical to Analytical: Synergizing Robotic Assistance with Customized Implants for Superior TKA Outcomes

Background Despite advancements in robotic-assisted total knee arthroplasty (TKA), improvements in patient satisfaction remain limited. This study aimed to compare outcomes and satisfaction among three TKA approaches: robotic-assisted TKA with patient-specific implants, robotic-assisted TKA with off-the-shelf implants, and manual TKA with off-the-shelf implants. Methods A retrospective cohort study was conducted on 140 knees who underwent TKA between December 2022 and December 2024. Patients were categorized into three groups: RA-C group (n = 43), which underwent robotic-assisted TKA with customized implants; RA-O group (n = 45), which received robotic-assisted TKA using Mako system with off-the-shelf implants; and Manual group (n = 52), which underwent conventional manual TKA using AK A3 GT implants. Customized implants in RA-C group were individually designed based on preoperative CT scans to optimize bony coverage and sagittal curvature, and featured separate medial and lateral tibial inserts. Outcomes included alignment, Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score (FJS), and a 5-level patient satisfaction scale. Results No significant differences were found in baseline demographics. In terms of post-operative outcomes, The RA-C group demonstrated significantly higher patient satisfaction than other groups (86.0% very satisfied, 11.6% satisfied and 2.3% neutral, p = 0.002). The RA-C group also presented a higher FJS-12 score (78.0 ± 14.2) compared to the Manual group (67.4 ± 20.2, p = 0.012). Conclusion Synergizing robotics with customized implants showed superior satisfaction and functional outcomes compared to robotic-assisted TKA with off-the-shelf implants and manual TKA. Individualized implant design, rather than robotics alone, may be more critical in optimizing TKA outcomes.