Pin-related complications in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis of 15,874 knees.

In 30 seconds

This systematic review and meta-analysis assessed pin-related complications after primary robotic-assisted total knee arthroplasty (RA-TKA), including 37 studies and 15,874 knees. The random-effects pooled complication rate was 0.47% (95% confidence interval [CI] 0.25-0.90%), while the crude rate was 0.89% (142/15,874). Wound complications and fractures were the most frequently reported events. Comparative analysis of four studies found no significant difference in complications between intra-incisional and extra-incisional pin placement. Most complications with reported management were treated nonoperatively.

Key findings

• The pooled pin-related complication rate was 0.47% (95% confidence interval [CI] 0.25-0.90%); the crude rate was 0.89% (142/15,874).
• Wound complications occurred in 0.59% and fractures in 0.15%; 69 of 93 wound complications (74.2%) involved extra-incisional tibial sites.
• Across four studies (5,635 knees), intra-incisional placement showed no significant difference in complications (risk ratio [RR] 0.25, 95% CI 0.03-2.06; P = 0.20; I² = 70%).
• Of 40 complications with reported management, 70% were managed nonoperatively.

Why it matters

Pin-related complications are uncommon in the reviewed RA-TKA literature, but wound problems and fractures are relevant adverse events. The concentration of reported wound complications at extra-incisional tibial sites may inform attention to pin-site outcomes, while the comparative analysis does not establish that one placement strategy is safer. These findings also highlight the value of consistent complication reporting.

What to keep in mind

The review reports substantial heterogeneity in the placement comparison (I² = 70%), which included only four studies. Mean follow-up was 10.7 months, and the authors call for further comparative studies and standardized reporting.