The use of technology during total knee arthroplasty (TKA)-specifically computer navigation (CN) and robotic assistance (RA)-has been associated with more accurate component position and less blood loss. Yet to date, the risk of developing prosthetic joint infection (PJI) associated with technology use has not been thoroughly evaluated. This study used propensity score matching (PSM) in a large cohort of primary TKA patients to compare the rate of PJI following conventional TKA (TKA) versus CN-TKA and RA-TKA.
We retrospectively reviewed 13,015 knees in 11,727 patients who underwent primary TKA at a single institution from 2018-2021. The cohort was stratified into TKA, CN-TKA, and RA-TKA groups. 1:1 PSM was applied to 11,834 patients. PSM was performed using logistic regression accounting for age, sex, body mass index, Charlson Comorbidity Index (CCI) score, CCI components, and smoking status to isolate the effect of technology on PJI risk. Univariate and multivariable analyses were performed to evaluate differences in surgical time and PJI rate.
Significantly median longer operating times were noted in the RA-TKA group (14 minutes) compared to TKA (P<0.001). The PJI rates among matched cohorts were similar among RA-TKA (0.3%), CN-TKA (0.3%), and conventional TKA (0.5%). Multivariable logistic regressions demonstrated that the use of robotic-assistance (Odds ratio (OR)=0.5, P=0.423) or computer-navigation (OR=0.61, P=0.128) was not associated with increased risk of PJI when compared to conventional TKA.
Use of computer navigation and robotic assistance during primary TKA are associated with longer surgical times, but no difference in PJI frequency within 90 days of surgery.

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