Robotic-Assisted versus Conventional Total Knee Arthroplasty: A Systematic Review of Functional Outcomes and Complications

Sachin N C; Tejal.VV; Dr. Vedavathi H

doi:10.51168/xqj0ef23

Autori

Sachin N C Senior Registar, Apollo Hospital, Bannerghatta Road , Bangalore -560076, Karnataka, India
Tejal.VV Resident, Indira Maternity and Skin Laser Center, Station Road, Tumkur- 572102 Karnataka, India
Dr. Vedavathi H Professor and Head, Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga 577201, Karnataka, India

DOI:

https://doi.org/10.51168/xqj0ef23

Cuvinte cheie:

robotic-assisted total knee arthroplasty, conventional total knee arthroplasty, patient-reported outcomes, complications, alignment, evidence synthesis

Rezumat

Background: Robotic-assisted total knee arthroplasty (RA-TKA) improves the reproducibility of bone resection, component positioning, and limb alignment, but its effect on patient-important outcomes remains debated. This review evaluates evidence available through November 2025 comparing RA-TKA with conventional total knee arthroplasty (C-TKA), with emphasis on validated functional outcomes, perioperative measures, and complications.

Methods: A structured evidence update was performed through 30 November 2025. Systematic reviews and meta-analyses of randomized controlled trials published between 2023 and 2025, together with randomized studies available by the cutoff date, were prioritized. Outcomes included Oxford Knee Score (OKS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), range of motion (ROM), pain, adverse events, operative time, blood loss, and radiographic alignment. Published pooled estimates were synthesized without re-pooling overlapping datasets.

Results: Randomized-trial meta-analyses consistently demonstrated fewer alignment outliers and smaller deviation from the planned mechanical axis with RA-TKA. A 2025 meta-analysis of 21 randomized trials involving 2,692 patients reported fewer alignment outliers (risk ratio 0.33, 95% confidence interval [CI] 0.19–0.59), a smaller mechanical-axis deviation (mean difference [MD] −0.93 degrees, 95% CI −1.20 to −0.66), a small KSS advantage (MD 1.03, 95% CI 0.50–1.57), no meaningful ROM benefit, and an increase in operative time of approximately 20 minutes. Most pooled PROMs and complication outcomes were similar between groups. One 180-patient randomized trial reported better 12-month PROMs and pain outcomes with an imageless handheld system, but the platform-specific and industry-funded design limits generalizability.

Conclusions: RA-TKA provides a consistent radiographic precision advantage, whereas evidence for a durable and clinically important functional benefit remains heterogeneous and platform-dependent. Long-term, independently funded trials using standardized PROMs, predefined alignment strategies, and economic evaluation are required.

Referințe

World Health Organization. Osteoarthritis. WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis

2. Long H, Liu Q, Yin H, Wang K, Diao N, Zhang Y, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Arthritis Rheumatol. 2022;74(7):1172–1183. doi:10.1002/art.42089.

3. DeFrance MJ, Scuderi GR. Are 20% of patients actually dissatisfied following total knee arthroplasty? A systematic review of the literature. J Arthroplasty. 2023;38(3):594–599. doi:10.1016/j.arth.2022.10.011.

4. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty. 2017;32(12):3854–3860. doi:10.1016/j.arth.2017.07.021.

5. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.

6. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane; 2024.

7. Mert Ü, Khasawneh MY, Ghandour M, Al Zuabi A, Horst K, Hildebrand F, et al. Comparative efficacy and precision of robot-assisted vs. conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2025;14(9):3249. doi:10.3390/jcm14093249.

8. Ruangsomboon P, Ruangsomboon O, Pornrattanamaneewong C, Narkbunnam R, Chareancholvanich K. Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop. 2023;94:60–79. doi:10.2340/17453674.2023.9411.

9. Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2024;34:1333–1343. doi:10.1007/s00590-023-03798-2.

10. Mostafa O, Malik M, Qayum K, Ishaq U, Khan AM, Wasim AS, et al. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes. Ann Med Surg (Lond). 2025;87(2):867–879. doi:10.1097/MS9.0000000000002919.

11. Bollars P, Nathwani D, Albelooshi A, Ettinger M, Verheyden F, Mievis J, et al. Imageless handheld robotic-assisted total knee arthroplasty showed better clinical outcomes than conventional total knee arthroplasty: a randomized controlled trial with preliminary results at 1-year follow up. Knee. 2025;56:232–240. doi:10.1016/j.knee.2025.05.028.

12. Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, Guyatt GH. Chapter 14: Completing summary of findings tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane; 2024.

13. Bollars P, Janssen D, De Weerdt W, Albelooshi A, Meshram P, Nguyen TD, et al. Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes. Knee Surg Sports Traumatol Arthrosc. 2023;31(12):5446–5452. doi:10.1007/s00167-023-07590-x.

14. Bollars P, Feyen H, Nathwani D, Albelooshi A, Ettinger M, De Corte R, et al. Postoperative changes in CPAK classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2025;33(9):3333–3340. doi:10.1002/ksa.12740.

15. Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. What is the minimum clinically important difference for the WOMAC Index after TKA? Clin Orthop Relat Res. 2018;476(10):2005–2014. doi:10.1097/CORR.0000000000000444.

16. Clement ND, Galloway S, Baron J, Smith K, Weir DJ, Deehan DJ. Patients undergoing robotic arm-assisted total knee arthroplasty have a greater improvement in knee-specific pain but not in function. Bone Joint J. 2024;106-B(5):450–459. doi:10.1302/0301-620X.106B5.BJJ-2023-1196.R1.

17. Fu X, She Y, Jin G, et al. Comparison of robotic-assisted total knee arthroplasty: an updated systematic review and meta-analysis. J Robot Surg. 2024;18:292. doi:10.1007/s11701-024-02045-y.

18. Daoub A, Qayum K, Patel R, Selim A, Banerjee R. Robotic assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials. J Robot Surg. 2024;18(1):364. doi:10.1007/s11701-024-02048-9.