HIstological features of resected bone tissue after total knee arthroplasty: mid-term outcomes

   Background: The accuracy of component positioning in robotic-assisted total knee arthroplasty (RaTKA) is unquestionable. Comparing RaTKA with conventional total knee arthroplasty (TKA), including histological examination of bone tissue following resection using different cutting instruments, remains clinically relevant.

   Objective: To investigate the histological features of bone resection performed with a robotic burr versus an oscillating saw and their impact on mid-term clinical outcomes after total knee arthroplasty.

   Materials and Methods. A comparative prospective two-center study was conducted from 2022 to 2025. Mean age: Group 1 (RaTKA) – 66,4 ± 8,3 years; Group 2 (TKA) – 66,59 ± 8,6 years. Median BMI: Group 1 – 30,28 (Q1 26,65; Q3 34,21) kg/m²; Group 2 – 33,91 (32,23; 36,93) kg/m². Hip-knee-ankle (HKA) angle: Group 1 – 171° (170°; 172°); Group 2 – 170° (170°; 173°). Patient outcomes were assessed using Visual Analog Scale (VAS) and WOMAC scores. Bone tissue microarchitecture was evaluated histologically.

   Results. In the RTKA group, early postoperative stiffness outcomes were superior. Over 1–3 years, functional scores demonstrated a statistically significant difference, with median values differing by 1–2 points. Histological analysis revealed that the extent of morphological bone tissue changes (microfractures, defects, necrosis) was 4,97-fold lower following RTKA compared to the conventional technique.

   Conclusion. Histologically, RaTKA is characterized by a 4,97-fold reduction in bone tissue damage and bone surface roughness (p < 0,05) relative to conventional TKA, without affecting three-year clinical outcomes.

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