{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:07:08Z","timestamp":1791504428230,"version":"4.3.4"},"reference-count":45,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,8,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the early comparative effectiveness of robotic versus conventional total knee replacement (TKR) and unicompartmental knee replacement (UKR) in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Target trial emulation study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Public and private hospitals using data from the National Joint Registry of England, Wales, Northern Ireland, the Isle of Man, Guernsey, and Jersey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>697\u2009145 knee replacement surgeries between 2018 and 2024: 675\u2009034 were conventional (TKRs and UKRs) and 22\u2009111 were robotic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The main outcome was five year knee replacement survival (mean 2.5 years follow-up); all cause revision risk; cause specific revision risk; intraoperative complications; and revision complexity of robotic versus conventional (TKR and UKR) knee replacement. Kaplan-Meier and Cox regression analyses were used to compare implant survival and indications for revision surgery. Propensity score matching using target trial emulation framework was used to estimate the average treatment effect in the treated population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The five year implant survival of the matched conventional and robotic TKR groups was 98.5% (95% confidence interval (CI) 98.3% to 98.7%) and 98.6% (98.2% to 99.0%), respectively, with no between group difference in revision risk (hazard ratio 1.03, 95% CI 0.86 to 1.26; P=0.71). The five year implant survival of the matched conventional and robotic UKR groups was 97.8% (95% CI 97.2% to 98.3%) and 96.4% (92.4% to 98.3%), respectively, with no between group difference in revision risk (hazard ratio 1.03, 95% CI 0.75 to 1.42; P=0.86). Cause specific revision risk and intraoperative complication risks did not differ between groups for either TKR or UKR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>No statistically significant differences were detected in revision risk, cause specific risk, or intraoperative complication risk between the robotic and conventional groups. This was consistent for both TKR and UKR. The possibility of unmeasured and residual confounding cannot be ruled out, however, owing to the observational design of the study. These results highlight the importance of careful evaluation of robotic technology in publicly funded healthcare systems, given the substantially higher capital and procedural costs involved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2026-100691","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:10Z","timestamp":1790812810000},"page":"e100691","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Early national comparison of robotic versus conventional knee replacements for arthritis using National Joint Registry data: target trial emulation study"],"prefix":"10.1136","volume":"394","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2146-8601","authenticated-orcid":true,"given":"Hasan R","family":"Mohammad","sequence":"first","affiliation":[{"name":"Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, E1 2AT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-0432","authenticated-orcid":true,"given":"Andrew","family":"Judge","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK"},{"name":"Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK"},{"name":"National Institute for Health and Care Research Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK"},{"name":"National Institute for Health and Care Research Applied Research Collaboration South West (NIHR ARC South West), University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier L","family":"Griffin","sequence":"additional","affiliation":[{"name":"Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, E1 2AT, UK"},{"name":"Barts Health NHS Trust, The Royal London Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Murray","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093021000717000_394.sep30_4.e100691.1","unstructured":"National Joint Registry . 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Robot-assisted surgery for orthopaedic procedures: early value assessment. Reccomendations for research. https:\/\/www.nice.org.uk\/guidance\/hte22\/chapter\/1-Recommendations. NICE 2025. [20 Aug 2026]."},{"key":"2026093021000717000_394.sep30_4.e100691.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.02.054"},{"key":"2026093021000717000_394.sep30_4.e100691.13","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002919"},{"key":"2026093021000717000_394.sep30_4.e100691.14","unstructured":"National Joint Registry. Data Completeness and Quality. https:\/\/reports.njrcentre.org.uk\/Data-Completeness-and-quality#:~:text=The%20linkability%20rate%20for%202024,registry%20since%202003%20is%2094.39%25. 2026. [20 Aug 2026]."},{"key":"2026093021000717000_394.sep30_4.e100691.15","unstructured":"National Joint Registry. 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