A Comparative Study on the Effectiveness of Robotic-Assisted Versus Conventional Total Knee Replacement in Terms of Functional Ability

 

Joseena SVM1, Geethu kurian2, Anjana Joshwa3, Rani Philip3, Riya Babu3,

Rose Maria Sunny3, Sirin Sunny3

1Principal, Little Lourdes College of Nursing, Kidangoor, Kottayam, Kerala, India, Pin code: 696572.

2Lecturer, Little Lourdes College of Nursing, Kidangoor, Kottayam, Kerala, India, Pin code: 696572.

3Students, Little Lourdes College of Nursing, Kidangoor, Kottayam, Kerala, India, Pin code: 696572.

*Corresponding Author E-mail: raniphilip13@gmail.com

 

ABSTRACT:

Total Knee Replacement (TKR) is a widely performed orthopedic surgical procedure for patients suffering from end-stage osteoarthritis, aimed at relieving pain and improving functional ability and quality of life. Despite its effectiveness, conventional TKR is associated with certain limitations such as variability in surgical accuracy, implant alignment issues, and prolonged recovery. Recent advancements in medical technology have introduced robotic-assisted TKR, which enhances surgical precision through real-time imaging and navigation systems. The present study aimed to compare the postoperative functional ability of patients undergoing conventional TKR and robotic-assisted TKR. A quantitative retrospective comparative research design was adopted. The study was conducted among 30 patients (15 conventional TKR and 15 robotic TKR) selected using purposive sampling technique from a selected private hospital in Kidangoor, Kottayam. Data were collected using a structured rating scale through telephonic interviews after 5 months of surgery. The findings revealed that in the robotic TKR group, 100% of patients achieved excellent functional ability, whereas in the conventional group, only 46.67% achieved excellent functional ability and 53.33% had average functional ability. The mean functional score of robotic TKR (26 ± 3.23) was significantly higher than conventional TKR (20.87 ± 4.16), with a statistically significant difference (t = 3.77, p < 0.05). The study concludes that robotic-assisted TKR is more effective than conventional TKR in improving postoperative functional ability.

 

KEYWORDS: Total Knee Replacement, Robotic-Assisted Surgery, Conventional Surgery, Functional Ability, Osteoarthritis.

 

 

 

1. INTRODUCTION:

The integration of technology in healthcare has led to significant advancements in patient care and treatment outcomes. One such innovation is AI-driven robotic surgery, which combines artificial intelligence (AI), machine learning, computer vision, advanced actuators, and 3D imaging technologies to enable ultra-precise minimally invasive interventions.1 The use of AI robotics in healthcare has expanded rapidly, enhancing clinical decision-making, improving surgical accuracy, and promoting patient safety. Three-dimensional (3D) imaging further strengthens this approach by providing detailed visualizations of anatomical structures, enabling better preoperative planning and intraoperative guidance. This fusion allows surgeons to navigate complex procedures with greater confidence, improving outcomes across specialties such as neurosurgery, orthopaedics, and oncology.2

 

Osteoarthritis is one of the most prevalent chronic degenerative joint disorders worldwide and a leading cause of pain, disability, and reduced quality of life, particularly among the elderly population. The knee joint is most commonly affected, resulting in progressive cartilage degeneration, joint space narrowing, stiffness, deformity, and decreased functional ability. Contributing factors such as aging, obesity, sedentary lifestyle, genetic predisposition, and previous joint injury significantly increase the risk and progression of knee osteoarthritis.1 As the disease advances, conservative management including medication, physiotherapy, and lifestyle modifications often becomes insufficient, necessitating surgical intervention. In response to these challenges, advanced technologies such as AI-driven robotic systems and 3D imaging have been increasingly integrated into orthopaedic practice, particularly in total knee replacement procedures. Robotic-assisted TKR utilizes preoperative 3D imaging to create a detailed, patient-specific model of the knee joint, enabling accurate surgical planning and simulation prior to the procedure.3

Many treatments are available for knee osteoarthritis ,including education ,exercise, footwears and weight reduction, followed by the use of analgesics and physical therapy, reserving non-steroidal anti inflammatory drugs, intra -articular interventions and surgery for the more severe cases.4 Total Knee Replacement (TKR) is a widely used surgical intervention for patients with knee osteoarthritis and other degenerative knee disorders, offering significant improvements in pain relief, functional restoration, and quality of life. It is a surgical procedure where damaged knee joint areas are replaced with artificial components.5 TKR effectively reduces pain and improves quality of life in patients with severe degenerative changes affecting the knee cartilage.6

 

Conventional method of surgery utilizes X-ray images and solely relies upon the visual evaluation of the surgeon and the utilization of direct manual surgery.7 It involves making an incision of around 10 to 12 inches long using standard surgical tools and equipment.8 It may lead to variations in surgical outcomes and compromise long term implant survival. The procedure takes a longer period to perform and can be extensive. There is a lot of involvement of skin and soft tissue that has to be stretched and lacerated during the procedure. The development of orthopaedics and particularly in total knee arthroplasty has engendered significant advancements in surgical precision and patient outcome.8 Robotic assisted surgery has emerged as a promising approach to enhance the precision, accuracy and reproducibility of TKR procedures. It utilizes advanced Robotic-assisted TKR utilizes preoperative 3D imaging to create a detailed, patient-specific model of the knee joint, enabling accurate surgical planning and simulation prior to the procedure.3 Many treatments are available for knee osteoarthritis ,including education, exercise, footwears and weight reduction, followed by the use of analgesics and physical therapy, reserving non-steroidal anti inflammatory drugs, intra -articular interventions and surgery for the more severe cases.4 Total Knee Replacement (TKR) is a widely used surgical intervention for patients with knee osteoarthritis and other degenerative knee disorders, offering significant improvements in pain relief, functional restoration, and quality of life. It is a surgical procedure where damaged knee joint areas are replaced with artificial components.5 TKR effectively reduces pain and improves quality of life in patients with severe degenerative changes affecting the knee cartilage.6 Conventional method of surgery utilizes X-ray images and solely relies upon the visual evaluation of the surgeon and the utilization of direct manual surgery.7 It involves making an incision of around 10 to 12 inches long using standard surgical tools and equipment.8 It may lead to variations in surgical outcomes and compromise long term implant survival. The procedure takes a longer period to perform and can be extensive. There is a lot of involvement of skin and soft tissue that has to be stretched and lacerated during the procedure. The development of orthopaedics and particularly in total knee arthroplasty has engendered significant advancements in surgical precision and patient outcome.8 Robotic assisted surgery has emerged as a promising approach to enhance the precision, accuracy and reproducibility of TKR procedures. It utilizes advanced imaging modalities and intraoperative navigation to provide real time feedback and assistance to the surgeon, enabling precise execution of bone cuts and optimization of implants positioning.6 Therefore in the present study we aim to provide a high level, evidence-based comparison between robotic total knee replacement and conventional method, focusing on the functional ability of the patients.9

 

2. MATERIALS AND METHODS:

The research approach selected for this study is quantitative approach and research design is a retrospective comparative study.10 The study is conducted in a selected private hospital, setting in Little Lourdes Mission Hospital, Kottayam. Selection of this setting is based on the   availability of samples, feasibility of conducting the study availability of orthopaedic surgical facilities including robotic-assisted TKR and accessibility of the hospital for data collection. The hospital is 18–20 km away from Kottayam railway station.

2.1. Sample Size Calculation:

The sample consists of 30 patients evaluated 5 months after undergoing both conventional TKR and robotic TKR surgery in a selected private hospital in Kidangoor Panchayath, Kottayam. Each sample are selected according to the inclusion criteria and exclusion criteria.

 

2.2. Inclusion and Exclusion Criteria:

Inclusion criteria were patients aged between 50–70 years (with reference from previous studies)1 who underwent unilateral TKR on the month of September 2025, whose surgery was conducted by same surgeon under same anaesthesia. Patients with unilateral TKR was taken because recovery of functional ability following bilateral TKR generally requires a longer rehabilitation period.

 

2.3. Data Collection Instrument:

The instrument used for this study is 3-point rating scale, where 3 is the score for maximum functional ability ,2 score for mild disability and 1 for moderate to severe disability. The data was collected using telephonic interview, to assess the post-operative functional ability after 5 months of both Conventional TKR and Robotic TKR. It consists of two sections namely,11

 

Section A: Demographic Data

The rating scale was prepared by the investigators and it includes the baseline data such as age, sex, occupation, education, nutritional status and support system in the family.

 

Section B: Rating Scale to Measure Functional Ability

This section B consists of 10 questions with 3-point scoring and the areas to assess the functional ability after surgery includes pain, mobility, strength, balance, stair climbing and descending, squatting and kneeling, recreational activities, daily activities, back to normal activities (overall functions) and health care satisfaction. The total number of questions are 10 and total Score is 30.

 

The total score is interpreted into different functional ability scores such as scores within the range of 1–10 is Poor Functional Ability, range between 11–20 is Average Functional Ability and 21–30 is Good Functional ability.

 

Patients were contacted over the phone and responses collected through electronic media (Google Form).

 

Distribution of Sample According to Demographic Variable:

Table 1: Distribution of samples according to demographic variables                                                                                          N=30

SL No

Socio Demographic Variables

Conventional Frequency

Conventional Percentage

Robotic Frequency

Robotic Percentage

1

Age

 

 

 

 

51–55 yrs

1

6.7%

2

13.3%

56–60 yrs

3

20%

6

40%

61–65 yrs

5

33.3%

4

26.7%

66–70 yrs

6

40%

3

20%

2

Sex

 

 

 

 

Male

2

13.3%

1

6.7%

Female

13

86.7%

14

93.3%

3

Education

 

 

 

 

Primary

1

6.66%

0

0%

Secondary

11

73.34%

14

93.34%

Degree

3

20%

1

6.66%

4

Occupation

 

 

 

 

Professional

0

0%

1

6.7%

Unskilled

2

13.3%

1

6.7%

Agriculture

1

6.7%

0

0%

Unemployed

10

66.7%

13

86.6%

Retired from job

2

13.3%

0

0%

5

Nutritional status

 

 

 

 

Vegetarian

1

6.7%

1

6.7%

Non vegetarian

14

93.3%

14

93.3%

6

Length of hospital stay after surgery

 

 

 

 

1-4

7

46.7%

11

73.3%

5-8

6

40%

4

26.7%

9-12

2

13.3%

0

0%

7

Support system in the family

 

 

 

 

Yes

15

100%

15

100%

No

0

0%

0

0%

 

 

Figure 1: Distribution of samples according to age

 

Figure 2: Distribution of samples according to sex

 

Association Between Demographic variables and postoperative functional ability among patients undergoing Total knee replacement.

Table 2: Distribution of sample according to the association between demographic variables and postoperative functional ability among patients underwent total knee replacement surgery.

Variables

Table value

Chi square

Significance

Age

2.138

3.87

P<0.05

Significant

Sex

0.266

0.076

P>0.05

Not significant

Education

0.93

1.57

P<0.05

Significant

Occupation

3.16

2.56

P>0.05

Not significant

Is there any suppoter in the family

3.31

0.376

P>0.05

Not significant

Length of hospital stay after surgery

1.47

2.386

P< 0.05

 significant

Nutritional status

3.33

0.773

P>0.05

Not significant

 

3. RESULT:

The present study was undertaken to assess the postoperative functional ability of patients after Conventional total knee replacement surgery and robotic total knee replacement surgery. The Discussion of the study is organized based on the objectives formulated.

 

Findings related to the postoperative functional ability of patients after conventional TKR and robotic TKR:

The present study was conducted among 30 samples, in which 15 samples after conventional TKR and 15 samples after robotic TKR. In the conventional TKR group, 7 (46.67%) people had good functional ability, 8 (53.33%) people had average functional ability, and none of them had poor functional ability. In the robotic TKR group, 15 (100%) people had good functional ability and none of them had average or poor functional ability. The mean score of conventional TKR was 20.87% (SD = 4.16) and the mean score of robotic TKR was 26% (SD = 3.23). and the t value (3.77) indicates that robotic TKR was more effective than conventional TKR and the difference was statistically significant (p < 0.05).

 

4. DISCUSSION

The findings of the present study is supported by another comparative cross-sectional study was conducted at care, hospital, Odisha, India conducted by Malik N, Malik A, Chowdhary A. The aim of the study was to compare early postoperative outcomes (pain, range of motion and functional mobility) among patients undergoing robotic total knee replacement (TKR) and traditional total knee replacement. Ethical approval was obtained on June la, 2023. The study included 30 patients who underwent unilateral total knee replacement, 15 patients done traditional TKR and 15 patients done robotic TKR within age group 45- 70 years and both male and female participants included. Sample size calculated using G* Power software. Block randomization method used to assign participants into two groups. Data instruments were numerical pain rating scale (NPRS), knee range of motion (KROM), lower extremity functional Scale (LEFS). Statistical analysis performed using IBM SPSS version 2.6 both groups showed 42 significant improvement (P<0.05) in NPRS scores as well as knee flexion and extension (P<0.05) In NPRS scores, as well as knee flexion and extension ROM from day 1 to day 7 post surgery. Between-group comparisons revealed that only knee flexion improved significantly (P20.05) ED The traditional group. No significant differences (P>0.05) were observed between the two groups. In other outcome measures, including lower-extremity functional cores by the and of the seventh postoperative day. The findings indicate that robotic total knee replacement (TKR) when combined with a structured and intensive rehabilitation program, provides greater short to midterm benefits in pain management, flexion recovery and functional improvement.12 Another randomized controlled study was conducted by Sang Eun Park MD and Chuns Tak Lee MD among 60 patients, including 30 conventional TKR and 30 robotic TKR patients. The knee society score of conventional TKR was 90.9 ± 4.88, and robotic TKR was 91.6 ± 2.94, which indicates that robotic TKR is more effective than conventional TKR.13

 

The findings of the present study were opposed by an observational study conducted at the Orthopaedic Hospital, Singapore by Liow M.H.L. et al. (2017). A total of 60 patients were included, in which 30 conventional TKR and 30 robotic TKR patients were taken. The mean functional score of conventional TKR was 87.4 (SD = 5.6) and robotic TKR showed a higher functional score. The mean functional score of conventional TKR was 87.4 (SD = 5.6) and the t Value was 0.87 (p > 0.05), which shows no significant difference.1

 

5. FINDINGS

Related to Association Between Selected Demographic Variables and Postoperative Functional Ability Among Patients After Total Knee Replacement:

The present study revealed that there is significant association between the selected demographic variables such as age, occupation, support system in the family, nutritional status and length of hospital stay among patients after total knee replacement.

 

However, there is no significant association between the selected demographic variables like sex and education after surgery among patients undergoing total knee replacement.

 

The findings of the present study were supported by a retrospective observational study conducted At Mayo Clinic Orthopaedic Department, USA by Singh J.A. et al. (2018). The sample consisted of 200 patients who underwent total knee replacement. The mean functional score of the age group less than 65 years was 88.3 ± 5.4, and that of the age group greater than 65 years was 82.6 ± 6.1. The t value was 4.21 (p < 0.05), which is significant. These findings indicate that younger patients had better postoperative functional ability, showing a significant association between age and functional outcome.

 

Another retrospective observational study was conducted at the Orthopaedic Department, USA by Singh J.A. et al. (2018). In this study, 300 patients who underwent TKR were selected. The mean functional score of patients with length of hospital stay ≤ 5 days was 90.1 ± 4.9, and those with length of hospital stay > 5 days was 84.7 ± 5.7. The t value was 3.76 (p < 0.05), which was statistically significant.14

 

Findings of the present study was opposed by a prospective observational study conducted at Orthopaedic hospital, Sweden by Nilsdotfer A.K. et.al (2017). The sample was 120 patients who underwent total knee replacement. The mean functional score of male gender was 88.1±5.4 and that of female gender was 87.3±5.8 and t=0.71, p>0.05(not significant). There was no significant association between gender and postoperative functional ability after TKR.3

 

6. LIMITATIONS:

The study is limited to:

·       only rely on verbal report

·       repeated calling was necessary to get adequate sample

·       complexity of human behavior while giving response

 

7. CONCLUSION:

The aim of the study was to compare the reported effectiveness of conventional total knee Replacement and robot‑assisted total knee replacement (RTKR). Functional ability rating scale result of conventional patient after conventional total knee replacement shows that, among 15 samples, 7 (46.67%) patients have excellent functional ability, 8 (53.33%) patients have good functional ability and none of them having poor functional ability and the functional ability rating scale result of patient after robotic TKR shows that among 15 samples, 15 (100%) patients have excellent functional ability, and none of them having poor functional ability. The mean percentage of conventional TKR was 20.87± 4.16 and robotic TKR was 26± 3.23(t value = 3.77, p<0.05), which indicates robotic TKR is more effective than conventional TKR in terms of functional Ability.

 

The findings of the study revealed that patients who underwent robotic TKR demonstrated better postoperative functional ability compared to those who underwent conventional TKR. However, the use of robotic technology in knee replacement surgery is often associated with high cost, 50 limited availability of equipment and need for specialized training of surgeons. To overcome these challenges in the future, it is necessary to promote cost effective robotic technologies, increased training program for healthcare professionals, and improved access to advanced surgical facilities in hospitals. Furthermore, healthcare policies and hospital management should focus on reducing treatment costs, increasing awareness among patients, and strengthening rehabilitation services to enhance postoperative recovery and long term prognosis. With continues advancement in medical technology and improved accessibility, robotic TKR may become a more widely available and effective treatment option for patients with severe knee joint disorders.

 

8. ETHICAL COMMITTEE:

The study was conducted at Little Lourdes mission hospital Kidangoor after obtaining permission from the principal of Little Lourdes College of Nursing and Orthopaedic Surgeon of Little Lourdes mission hospital, Kidangoor. Prior to the collection of data the researchers explained the purpose of the study and obtained consent from each sample. The researchers gave assurance regarding the confidentiality of the data collected from the sample. Ethical Committee approved research study on 31/1/2026 and Institutional committee approved on 12/12/26.

 

8.1 ETHICAL APPROVAL:

The study was approved by the ethical committee on 31/1/26 and institutional committee approved the study on 12/12/26.

 

9. CONFLICT OF INTEREST:

None.

 

10. APPENDIX: 1

10.1 Appendix: 1

Functional Ability Rating Scale:

A Study to Compare the Patient Outcome of Patients Who Underwent Robotic Versus Conventional Total Knee Replacement Surgery in A Selected Private Hospital Kidangoor, Kottayam

 

Instructions:

·       Every Questions should be answered.

·       Choose only one option for each questions.

·       Put (✓) mark for each correct options.

 

Section A:

Patient Details:

·       Age:

·       Sex:

·       Education:

·       Occupation:

·       Support system in the family:

·       Nutritional status:

 

 

Appendix: 1-Table.

Parameters

3

2

1

Pain

No Pain

Mild pain, Occasional

Moderate Pain, Frequent

Mobility

No limitation, able to walk without assistance

Mild limitation, able to walk with assistance (e.g., cane)

Moderate limitation, able to walk short distances (<500m)

Strength

Normal strength, able to perform daily activities without difficulty

Mild weakness, able to perform daily activities with some difficulty

Moderate weakness, able to perform daily activities with significant difficulty

Range of Motion

Full range of motion (0-120°)

Mild limitation (90-120°)

Moderate limitation (60-90°)

Daily Activities

Able to perform all daily activities without difficulty

Able to perform most daily activities with some difficulty

Able to perform some daily activities with significant difficulty

Balance And Stability

Normal balance and stability

Mild impairment, occasional loss of balance

Moderate impairment, frequent loss of balance

Stair Climbing

Able to climb stairs without difficulty

Able to climb stairs with some difficulty

Able to climb stairs with significant difficulty

Squatting And Kneeling

Able to squat and kneel without difficulty

Able to squat and kneel with some difficulty

Able to squat and kneel with significant difficulty

Recreational Activities

Able to participate in recreational activities without difficulty

Able to participate in recreational activities with some difficulty

Able to participate in recreational activities with significant difficulty

Overall Functions

Excellent, able to perform all activities without difficulty

Good, able to perform most activities with some difficulty

Fair, able to perform some activities with significant difficulty

Healthcare Satisfaction

Very Satisfied

Satisfied

Dissatisfied

Total Score: 30

Interpretation: 1-10: Poor Functional Ability ; 11-20: Average Functional Ability; 21-30: Good Functional Ability

 

10.2 Appendix 2

 

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Received on 27.05.2026         Revised on 20.06.2026

Accepted on 11.07.2026         Published on 05.08.2026

Available online from August 10, 2026

A and V Pub Int. J. of Nursing and Med. Res. 2026; 5(3):145-151.

DOI: 10.52711/ijnmr.2026.32

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