{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:45:52Z","timestamp":1793533552511,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Robotic-assisted total knee arthroplasty (RA-TKA) may disproportionately affect revision rates based on a surgeon\u2019s revision profile. This national registry study (1) stratified surgeons by pre\u2013RA-TKA revision rates as low, medium, or high and (2) compared the change in revision rates and modes of failure within each cohort after commencing RA-TKA.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n All TKA procedures performed for osteoarthritis and recorded by the Australian Orthopaedic Association National Joint Replacement Registry from September 1999 to December 2023 were screened for eligibility. A total of 178 surgeons were included, performing 85,075 TKAs since commencing RA-TKA. TKA with hinged, constrained or medial pivot bearings, and American Society of Anesthesiologists (ASA) Scores 4 and 5 were excluded. Surgeons were stratified into quartiles based on their 2-year cumulative-percent-revision (CPR) rates before commencing RA-TKA into low (2-year CPR \u22641%), middle (1%-2.5%), and high revision cohorts (\u22652.5%). The primary outcome was CPR with comparisons between time-matched RA-TKA and non-RA-TKA for each surgeon cohort after commencing RA-TKA. Secondary outcomes were changes in failure modes. Cox proportional hazards modelling controlled for age, sex, body mass index, ASA, patellar resurfacing, surgical year, fixation, polyethylene, and bearing type.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n After commencing RA-TKA, there was no difference in CPR between RA-TKA and non-RA-TKA in low (hazard ratio [HR] 1.27; 95% CI 0.84-1.91;\n p<\/jats:italic>\n = 0.26) and middle-revision rate surgeon groups (HR 0.99; 95% CI 0.83-1.19;\n p<\/jats:italic>\n = 0.95). High-revision rate surgeons had decreased three-month CPR (HR 0.51; 95% CI 0.34-0.75;\n p<\/jats:italic>\n < 0.001) but increased >9-month CPR (HR 2.28; 95% CI 1.74-2.98;\n p<\/jats:italic>\n < 0.001). The mean follow-up was 2.4, 2.4 and 2.3 years, respectively, with maximum 7-year follow-up. Failure modes including infection, loosening, and instability did not change within any revision rate cohort after commencing RA-TKA (\n p<\/jats:italic>\n > 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n At a grouped cohort level, commencing RA-TKA does not improve revision rates nor change failure modes. Surgeons with higher revision rates before commencing RA-TKA experienced further increases in revision rates.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00127","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T18:06:19Z","timestamp":1781546779000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Does Transitioning to Robotic-Assisted Total Knee Arthroplasty Change Surgeon Revision Risk or Failure Modes?"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-3065","authenticated-orcid":false,"given":"Wayne","family":"Hoskins","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8897-3688","authenticated-orcid":false,"given":"Charles","family":"Gusho","sequence":"additional","affiliation":[{"name":"Missouri Orthopaedic Institute, The University of Missouri, Columbia, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1656-5762","authenticated-orcid":false,"given":"Roger","family":"Bingham","sequence":"additional","affiliation":[{"name":"Traumaplasty. Melbourne, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2486-9814","authenticated-orcid":false,"given":"Peiyao","family":"Du","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-7615","authenticated-orcid":false,"given":"Helena","family":"Oakey","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9360-4406","authenticated-orcid":false,"given":"Kelly G","family":"Vince","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4460-5568","authenticated-orcid":false,"given":"Michael","family":"McAuliffe","sequence":"additional","affiliation":[{"name":"Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia"},{"name":"Queensland University of Technology, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"issue":"3","key":"R1-20260615","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.2106\/JBJS.OA.24.00063","article-title":"Robots on the stage: a snapshot of the American robotic total knee arthroplasty market","volume":"9","author":"Inabathula","year":"2024","journal-title":"JBJS Open Access"},{"issue":"3","key":"R3-20260615","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s12178-020-09625-z","article-title":"Robots in the operating room during hip and knee arthroplasty","volume":"13","author":"Sousa","year":"2020","journal-title":"Curr Rev Musculoskelet Med."},{"issue":"12","key":"R4-20260615","doi-asserted-by":"crossref","first-page":"3474","DOI":"10.1016\/j.arth.2020.06.072","article-title":"Robotic surgery in total joint arthroplasty: a survey of the AAHKS membership to understand the utilization, motivations, and perceptions of total joint surgeons","volume":"35","author":"Sherman","year":"2020","journal-title":"J Arthroplasty"},{"issue":"4","key":"R5-20260615","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.arth.2020.10.033","article-title":"The impact of author financial conflicts on robotic-assisted joint arthroplasty research","volume":"36","author":"DeFrance","year":"2021","journal-title":"J Arthroplasty"},{"issue":"6","key":"R6-20260615","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-1355.R2","article-title":"Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial","volume":"103-B","author":"Banger","year":"2021","journal-title":"Bone Jt J."},{"issue":"8","key":"R7-20260615","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2106\/JBJS.15.00664","article-title":"Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study","volume":"98","author":"Bell","year":"2016","journal-title":"J Bone Jt Surg."},{"issue":"9","key":"R8-20260615","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1097\/CORR.0000000000001324","article-title":"Are there differences in accuracy or outcomes scores among navigated, robotic, patient-specific instruments or standard cutting guides in TKA? A network meta-analysis","volume":"478","author":"Bouch\u00e9","year":"2020","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"R9-20260615","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-0602.R2","article-title":"A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty","volume":"103-B","author":"Kayani","year":"2021","journal-title":"Bone Jt J."},{"key":"R10-20260615","first-page":"31","article-title":"HURWA robotic-assisted total knee arthroplasty improves component positioning and Alignment\u2013A prospective randomized and multicenter study","volume":"33","author":"Li","year":"2022","journal-title":"J Orthop Transl"},{"issue":"9","key":"R11-20260615","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1007\/s00167-016-4076-3","article-title":"Robotic\u2010assisted total knee arthroplasty may lead to improvement in quality\u2010of\u2010life measures: a 2\u2010year follow\u2010up of a prospective randomized trial","volume":"25","author":"Liow","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"12","key":"R12-20260615","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1016\/j.arth.2013.12.010","article-title":"Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. 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The 2-year clinical outcomes of a randomized controlled trial","volume":"33","author":"Gilmour","year":"2018","journal-title":"J Arthroplasty"},{"issue":"2","key":"R18-20260615","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/CORR.0000000000000916","article-title":"Does robotic-assisted TKA result in better outcome scores or long-term survivorship than conventional TKA? 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A study from the Australian orthopaedic association national joint replacement registry","volume":"480","author":"Hoskins","year":"2022","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"R27-20260615","doi-asserted-by":"crossref","first-page":"168","DOI":"10.5435\/JAAOS-D-21-00309","article-title":"The cost-effectiveness of robotic-assisted versus manual total knee arthroplasty: a Markov model\u2013based evaluation","volume":"30","author":"Rajan","year":"2022","journal-title":"J Am Acad Orthop Surg."},{"issue":"4","key":"R28-20260615","doi-asserted-by":"crossref","first-page":"dyaf078","DOI":"10.1093\/ije\/dyaf078","article-title":"Data resource profile: the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)","volume":"54","author":"Zhou","year":"2025","journal-title":"Int J Epidemiol."},{"issue":"2","key":"R29-20260615","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/CORR.0000000000003217","article-title":"What are the relative associations of surgeon performance and prosthesis quality with THA revision rates?","volume":"483","author":"Hoskins","year":"2025","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"R30-20260615","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/CORR.0000000000002783","article-title":"Robotic-assisted TKA is not associated with decreased odds of early revision: an analysis of the American Joint Replacement Registry","volume":"482","author":"Kirchner","year":"2024","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"R31-20260615","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/CORR.0000000000003330","article-title":"Robotic assistance is not associated with decreased early revisions in cementless TKA: an analysis of the American Joint Replacement Registry","volume":"483","author":"Kirchner","year":"2025","journal-title":"Clin Orthop Relat Res."},{"key":"R32-20260615","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2025.03.047","article-title":"Navigated and robotic total knee arthroplasty do not confer improved 5-Year survivorship compared to conventional TKA: an analysis from the American joint replacement registry","author":"Pius","year":"2025","journal-title":"J Arthroplast"},{"issue":"8","key":"R33-20260615","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1016\/j.arth.2022.03.060","article-title":"Adverse events associated with robotic-assisted joint arthroplasty: an analysis of the US Food and Drug Administration MAUDE Database","volume":"37","author":"Pagano","year":"2022","journal-title":"J Arthroplasty"},{"key":"R34-20260615","doi-asserted-by":"crossref","first-page":"1120908","DOI":"10.3389\/fsurg.2023.1120908","article-title":"Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?","volume":"10","author":"Morcos","year":"2023","journal-title":"Front Surg."},{"issue":"12","key":"R35-20260615","doi-asserted-by":"crossref","first-page":"3230","DOI":"10.1002\/ksa.12311","article-title":"Effect of joint-line obliquity on long-term survivorship of total knee arthroplasty: a postoperative phenotype analysis","volume":"32","author":"Bae","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"10","key":"R36-20260615","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.2106\/JBJS.RVW.23.00062","article-title":"A systematic review of data collection by national joint replacement registries: what opportunities exist for enhanced data collection and analysis?","volume":"11","author":"Hoskins","year":"2023","journal-title":"JBJS Rev."},{"key":"R37-20260615","first-page":"1097","article-title":"Do the revision rates of arthroplasty surgeons correlate with postoperative patient-reported outcome measure scores? A study from the Australian Orthopaedic Association National Joint Replacement Registry","volume":"10","author":"Hoskins","year":"2022","journal-title":"Clin Orthop Relat Res."},{"issue":"25","key":"R38-20260615","first-page":"01229","article-title":"Fellowship training in adult reconstruction is associated with decreased complications up to two years following total knee arthroplasty","volume":"S0883-5403","author":"Katanbaf","year":"2025","journal-title":"J Arthroplasty"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:22Z","timestamp":1787751682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00127"}},"subtitle":["A Baseline Comparative Analysis Before and After Robotic Adoption"],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00127","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}