Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2025; 92(5):282-287 | DOI: 10.55095/achot2025/024

One Year of Experience with Robotic Total Knee Arthroplasty – ROSA System

PATRIK MUSIL, ROMAN LEHOVEC

Klinika Dr. Pírka, Mladá Boleslav

Purpose of the study:  The study aimed to evaluate the initial experience with robot-assisted total knee arthroplasty (TKA) using the ROSA system. It focuses on surgical techniques, alignment options, and the pros and cons of the system. It also provides an analysis of the pre- and post-operative range of motion measured by the robotic system.

Material and methods:  In the period from 5 December 2023 to 8 August 2024, a total of 197 total knee arthroplasties were performed at the Dr. Pírek Clinic using the ROSA system and Persona implants with a medial congruent tibial insert. Complete data were available for 124 patients (63 men, 61 women) with a mean age of 68.7 ± 8.2 years and a mean BMI of 30.6 ± 4.3. The mean length of hospital stay was five days. Preoperative and postoperative assessments included the range of motion (flexion and extension), soft tissue laxity (varus and valgus stress tests), and data on the planned axial position of the limb. A t-test was used for statistical comparisons. The surgeries were performed using the “image-less” mode of the ROSA system. All procedures were performed via a medial parapatellar approach. After thorough cleaning of the joint and positioning of trackers, the total range of motion and laxity of the joint were measured. Soft tissue balance was ensured based on kinematic alignment principles.

Results:  The study confirmed an improvement in the range of motion and accuracy of limb axis alignment. Statistical analysis showed significant postoperative improvement in flexion and mechanical axis. The use of the ROSA system enabled precision in bone cuts and increased reproducibility of results with the aim of maintaining the predefined limits for the resulting limb axis.

Discussion:  The results obtained are consistent with those reported in the available literature, indicating that robot-assisted TKA helps improve surgical accuracy and reduce the incidence of deviations. Compared to conventional methods, robotic assistance requires less soft tissue release and can thus minimize blood loss. The disadvantages of this system include operative time and cost. Another challenge, for surgeons, is the learning curve and variability of approaches to alignment. The study also underlines the importance of personalized alignment, as different knee phenotypes may require different approaches.

Conclusions:  Robot-assisted TKA using the ROSA system offers advantages in terms of surgical precision, reproducibility of results, and early postoperative functional recovery. The study indicates that the introduction of robotic systems may help improve patient satisfaction and long-term implant durability. However, further research with larger patient cohorts and long-term follow-up is necessary to confirm these results.

Keywords: total knee arthroplasty, robot-assisted orthopaedic surgery, ROSA system, kinematic alignment, mechanical alignment, functional alignment, range of motion, robotic orthopaedic surgery, osteoarthritis.

Received: March 31, 2025; Revised: March 31, 2025; Accepted: May 25, 2025; Published: December 1, 2025  Show citation