Robotic total knee arthroplasty with functional alignment yields comparable outcomes across age and gender groups.

Objectives: Age and gender can influence total knee arthroplasty (TKA) outcomes, complications, and revision rates. Functional alignment (FA), a personalized approach guided by robotic systems, has emerged as a strategy to optimize outcomes by addressing patient-specific anatomy and laxities. However, limited evidence exists regarding the influence of age and gender on outcomes of FA-guided robotic-assisted TKA.

Methods: This retrospective study evaluated 353 patients who underwent robotic-assisted TKA guided by FA principles with a minimum of 2 years of follow-up. Patients were divided into groups based on age (≥75 years vs. <75 years) and gender (males vs. females). Outcomes assessed included functional scores [Knee Society Score (KSS) and Forgotten Joint Score (FJS)], complications, and revision rates. Coronal alignment was evaluated using preoperative and postoperative full-length weight-bearing X-rays and the data from the robotic system.

Results: Preoperative clinical and radiographic evaluations showed no statistically significant differences between age groups. Females had more valgus preoperative alignment compared to males. Postoperatively, functional outcomes (KSS and FJS) and coronal alignment were comparable across all groups, with the only exception being the female group, which reported statistically significant higher FJS scores (P ​= ​0.02) despite similar KSS scores. Complication and revision rates did not differ in a statistically significant manner between groups.

Conclusions: This study demonstrated that robotic-assisted TKA guided by FA yields comparable outcomes, complication rates, and revision rates across gender and age groups. These findings suggest that FA may help reduce demographic disparities by providing consistent outcomes across diverse patient populations.

Level Of Evidence: III.