The Dark Side of Precision: Pin-Related Complications in Computer-Navigated and Robotic-Assisted Knee Arthroplasty

"Background: With the rising volume of knee arthroplasty and increasing adoption of robotic- and computer-assisted systems, the routine use of tracker pins has introduced procedure-specific risks. This systematic review aimed to characterize the types and incidence of pin-site complications associated with robotic-assisted and computer-navigated primary knee arthroplasty and to describe the timing, management strategies, and reported outcomes. Methods: A PRISMA-guided search of PubMed/MEDLINE was performed... Results: From 1231 initial records, 28 studies met the inclusion criteria, comprising 15,004 cases in cohort/series analyses. The aggregate pin-related complication incidence in non-case-report series was 0.95% (142 events). Conclusions: Pin-related complications after robotic- and computer-assisted knee arthroplasty are uncommon but clinically significant (≈0.95%). There is insufficient evidence to define optimal pin-placement strategies or fixation configurations. Surgeons should include pin-related risks in informed consent discussions."