Comparative pain relief and functional outcomes following robotic-assisted versus conventional total knee arthroplasty: a GRADE-assessed meta-analysis with meta-regression of randomized controlled trials
Abstract
Although robotic-assisted total knee arthroplasty (RA-TKA) is increasingly adopted for its potential to improve surgical precision, its impact on functional outcomes compared with conventional TKA (C-TKA) remains unclear. Existing syntheses are limited by pooling observational and randomized data, focusing on absolute postoperative scores without evaluating recovery trajectories, and lacking rigorous exploration of heterogeneity. To overcome these limitations, we conducted a methodologically rigorous meta-analysis of randomized controlled trials (RCTs) only, incorporating comprehensive meta-regression, platform-specific subgroup analyses, and assessment of evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. PubMed, Web of Science, Scopus, the Cochrane Library, and Google Scholar (pages 1-50) were comprehensively searched from their inception up to December 27, 2025. Data were pooled using random-effects meta-analysis and Hartung-Knapp adjustments. Meta-regression of different moderators and subgroup analyses by robotic platforms were performed, when feasible, to identify sources of heterogeneity. A total of 24 RCTs encompassing 3,425 patients were included. The pooled analyses demonstrated no significant differences between RA-TKA and C-TKA for change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (MD 0.14; 95% CI - 5.88 to 6.16; p = 0.96), change in functional Knee…
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: 3,425 participants or records.
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