Comparative Efficacy and Precision of Robot-Assisted vs. Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,614 participants or records.
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