Robotic-Assisted versus Conventional Manual Total Knee Arthroplasty: A Systematic Review of Clinical and Radiographic Outcomes

Abstract

Introduction: Total knee arthroplasty (TKA) is a highly successful operation for end-stage osteoarthritis. Robotic-assisted TKA has been developed to enhance the precision of implant placement and limb alignment. This systematic review evaluates whether this improved technical accuracy translates into superior clinical and radiographic outcomes compared to conventional manual TKA.

Methods: A comprehensive search of MEDLINE, Embase, and the Cochrane Library was conducted for randomized controlled trials (RCTs). We included studies directly comparing robotic-assisted TKA to conventional manual techniques. Primary outcomes were radiographic accuracy of component alignment and postoperative functional scores (e.g., Knee Society Score, WOMAC).

Results: The meta-analysis included 25 RCTs. Robotic-assisted TKA was consistently associated with more accurate implant positioning and a significantly lower percentage of alignment outliers compared to the conventional manual technique. Some studies reported modest improvements in early postoperative pain and functional recovery, but these differences did not typically persist at mid- to long-term follow-up.

Discussion: The primary advantage of robotic assistance in TKA is the reliable improvement in surgical precision. While the long-term clinical benefit of this improved alignment is still under investigation, the technology effectively minimizes technical errors. The higher cost and longer operative time associated with robotics are important considerations.

Conclusion: Robotic-assisted total knee arthroplasty provides superior radiographic accuracy compared to conventional techniques, though its benefit on long-term clinical function is not yet established.