Research progress on tracker fixation strategies and related complications in robot-assisted total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jinsheng ¹ , WANG Hui ¹ , LI Dezheng ¹ , CHENG Qinghao ² ,  GUO Hongzhang ²

1. First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou Gansu, 730030, P. R. China;
2. The First Ward of Joint Surgery, Gansu Provincial Hospital, Lanzhou Gansu, 730030, P. R. China;

Corresponding?author：

GUO Hongzhang, Email: g_hz@163.com

Keywords：

Total knee arthroplasty; robot-assisted surgery; tracker pin; pin sites; complication

DOI：

10.7507/1002-1892.202512103

Video：

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Objective To review the primary tracker fixation strategies and associated complications in robot-assisted total knee arthroplasty (RA-TKA), evaluate their respective advantages, limitations, and clinical outcomes, and provide evidence-based references for clinical practice. Methods A comprehensive review of the current literature regarding tracker fixation techniques and related complications in RA-TKA was conducted. The analysis primarily focused on key procedural variables, including the depth of pin penetration (unicortical versus bicortical) and the insertion trajectory (intra-incisional versus independent/percutaneous incision). Results Current research predominantly centers on two parameters: the number of cortices penetrated by the fixation pins and the spatial relationship between the pin insertion site and the primary surgical approach. Existing evidence indicates that unicortical fixation at the medial epicondylar region of the femur, combined with an independent, small-incision unicortical fixation on the tibial side, yields superior mechanical stability, minimizes intraoperative tracker micro-motion, and demonstrates an excellent safety profile. The overall incidence of tracker-related complications remains low; these primarily include localized pain, soft tissue irritation, pin-tract infections, and, rarely, iatrogenic fractures. The majority of these complications have favorable prognoses. Conclusion A standardized clinical consensus on tracker fixation protocols in RA-TKA has yet to be established. In clinical practice, surgeons should employ individualized fixation strategies tailored to the patient’s bone quality, local anatomy, and surgical expertise. Prioritizing minimally invasive, highly stable, and low-risk fixation options is crucial to mitigating iatrogenic injury without compromising surgical precision.

Citation： WANG Jinsheng, WANG Hui, LI Dezheng, CHENG Qinghao, GUO Hongzhang. Research progress on tracker fixation strategies and related complications in robot-assisted total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(5): 808-814. doi: 10.7507/1002-1892.202512103 Copy

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9. Kayani B, Konan S, Tahmassebi J, et al. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J, 2018, 100-B(7): 930-937.
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21. Jung KA, Lee SC, Ahn NK, et al. Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty, 2011, 26(3): 505.e9-505.e11.
22. McChesney GR, Morris RP, Al Barghouthi A, et al. How does tibial pin placement in navigated total knee arthroplasty affect the torsional strength of the tibia? J Am Acad Orthop Surg, 2022, 30(2): e279-e286.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress on tracker fixation strategies and related complications in robot-assisted total knee arthroplasty

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