Effectiveness and safety of robotic-assisted total knee arthroplasty versus conventional manual technique: a systematic review focusing on clinical and functional outcomes

Alfredo Carlos Chávez; Omar Antonio González Juárez; Cristian Santiago García Guartizaca; Sebastián Barragán Barreto; Lidia Leonor Chanchay Pillajo; Raúl Ortega Calixto; Maximiliano Cueva Pérez

doi:10.18203/issn.2455-4510.IntJResOrthop20253739

Authors

Alfredo Carlos Chávez Orthopedics and Traumatology Department, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad No. 21; Colegio Mexicano de Ortopedia y Traumatología; Universidad de Monterrey, Monterrey, México https://orcid.org/0009-0009-8496-0239
Omar Antonio González Juárez Medicine Department, Instituto Tecnológico y de Estudios Superiores de Monterrey, Ciudad de México, México https://orcid.org/0009-0000-4647-9828
Cristian Santiago García Guartizaca Medicine Department, Universidad Técnica de Machala, Machala, Ecuador https://orcid.org/0009-0007-7814-4089
Sebastián Barragán Barreto Medicine Department, Fundación Universitaria Sanitas, Bogotá, Colombia; Hospital Keralty, Bogotá, Colombia https://orcid.org/0009-0008-3425-8022
Lidia Leonor Chanchay Pillajo Department of Health Sciences, Universidad Central del Ecuador; Master’s in Health Management for Local Development; Occupational Therapy Program, Quito, Ecuador https://orcid.org/0009-0006-8832-2937
Raúl Ortega Calixto Orthopedics and Traumatology Department, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Ciudad de México, México https://orcid.org/0009-0002-4654-7231
Maximiliano Cueva Pérez Medicine Department, Universidad Autónoma de Guadalajara, Guadalajara, México https://orcid.org/0009-0003-4123-2983

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253739

Keywords:

Accuracy, Functional outcomes, Prosthesis alignment, Robotic surgery, Safety, Total knee arthroplasty

Abstract

Robotic-assisted total knee arthroplasty (RA-TKA) improve surgical precision over conventional manual TKA (CM-TKA). This review discussed their clinical and functional outcomes and safety. A PRISMA-compliant systematic review of comparative studies from multiple databases up to October 2024. Data were pooled for key outcomes. RA-TKA significantly reduced mechanical alignment outliers (RR=0.33, 95% CI 0.19-0.59) and mean deviation from neutral axis (MD=-0.93°). Operative time was longer for RA-TKA (MD=+19.94 minutes). Analysis of patient-reported outcomes showed a statistically significant but clinically insignificant improvement in Knee Society Score (MD=+1.03 points). No significant differences were found in WOMAC, Oxford Knee Scores or overall complication and revision rates. However, RA-TKA was associated with a higher Forgotten Joint Score at 1, 2, and 5 years and improved early gait stability. Some cohorts reported shorter hospital stays and higher patient satisfaction (95.0% vs. 87.4%) with robotics. Registry data confirmed no reduction in early revision risk. RA-TKA provides superior alignment but no consistent functional superiority or safety advantage over CM-TKA.

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