The most important finding of this study is that intraoperative sensor-assisted TKA did not yield better postoperative patient-reported outcomes than manual primary TKA. The present finding rejects our hypothesis.
While the use of intraoperative sensors during TKA can aid in achieving a balanced knee, it does not necessarily result in superior patient-reported outcomes. As previously stated in the introduction, achieving soft tissue balance with good intra-articular stability is vital for long-term success of TKA, as it can improve patient satisfaction and prolonging the survivorship of prosthesis 11–13. As a result, sensor-assisted TKA should lead to a superior patient-reported outcome than manual TKA. Although one included study reported a significant difference between sensor-assisted and manual primary TKA in terms of Knee Society Score and Oxford Knee Score 14, the reported score difference did not meet the minimum clinically important difference of the two questionnaires used 15. Consequently, there appears to be no clinical meaningful differences regarding postoperative patient-reported outcomes between the two TKA techniques across all included studies. It is worth noting that the current findings are based on studies with short-term postoperative follow-ups, with a mean duration ranging from 0.5 to 2 years. The length of follow-up period can impact the patient-reported outcomes that are determined 16. Extending the postoperative follow-up length may help clarify any potential differences between intraoperative sensor-assisted and manual primary TKA. Furthermore, it should be acknowledged that the results of the included studies may be constrained by the number of patients included. As highlighted by Giuntoli et al. 17, their analysis encompassed only 10 patients in each group, which resulted in insufficient statistical power to detect meaningful difference between the groups. Moreover, it is important to note that the studies included in this review only used a single sensor brand, VERASENSE knee system, and there is a dearth of evidence regarding the patient-reported outcome comparison of eLIBRA dynamic knee balancing system 10, another sensor brand, with manual primary TKA. Future research is necessary to address this gap in knowledge.
A rigorous evaluation of the intraoperative sensor technology used in TKA is imperative. Although sensor-assisted TKA may not demonstrate superiority in patient-reported outcomes than manual TKA, it can have other advantages, such as offering a valuable opportunity for knee surgeons to learn how to achieve a balanced knee, particularly for those who are less experienced. However, there are drawbacks, including increased medical cost and limitations on choosing TKA prosthesis 18. For example, the eLIBRA dynamic knee balancing system is currently only suited for the Zimmer Biomet total knee system19, which restricts its clinical utilization. Additionally, future studies are needed to assess the long-term cost-effectiveness of incorporating sensor-technology in TKA, which can help knee surgeons and policymakers make more informed decisions regarding its implementation in clinical practice.
One of the strengths of this review is that it provides an overview of the current evidence on intraoperative sensor-assisted TKA’s impact on postoperative patient-reported outcomes, without language or time restrictions during the search process. This information can be valuable for knee surgeons when considering whether or not to use sensors in TKA procedures, as it allows for informed decision-making based on the available evidence.
While this review provides insights into the patient-reported outcomes of sensor-assisted TKA, there are some limitations to consider. For instance, the low number of clinical studies included in the analysis limits the generalizability of the findings. Additionally, the present study only examines the postoperative patient-reported outcome and does not consider objective outcome measures such as radiological assessments or gait analysis. Furthermore, the follow-up duration in the included studies is relatively short for assessing patient-reported outcomes. This limitation can be attributed to the novelty of sensor technology in clinical practice. Additionally, some current studies have employed robots to assist in TKA, but they still face challenges to soft tissue balancing.
To advance this filed, a promising direction for future research involves combining robotic assistance with sensor technology in TKA procedures. This integrated approach has the potential to overcome existing limitations and enhance patient-reported outcomes. Consequently, future research efforts should prioritize addressing these shortcomings and include a more extensive follow-up period to yield a more comprehensive understanding of the impact of intraoperative sensor-assisted TKA.