Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes

Abstract

Background: Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an alternative to conventional TKA (C-TKA), aiming to improve surgical precision and patient outcomes. This systematic review and meta-analysis study compares the efficacy of RA-TKA versus C-TKA.

Methods: A comprehensive search of five databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Library) was conducted. We included all published randomized controlled trials (RCTs) from inception to August 2024. Meta-analysis was done using RevMan 5.4 package.

Results: Twenty-one RCTs involving 2692 patients were involved. RA-TKA demonstrated significantly lower mechanical alignment outlier rates (risk ratio = 0.33, 95% confidence interval (CI)[0.19, 0.59], P = 0.0002) and less deviation from neutral mechanical axis (mean difference, MD = -0.93° [-1.20, -0.66], P < 0.00001) compared to C-TKA. No significant differences were found in WOMAC or Oxford Knee Scores at various follow-up points. RA-TKA was associated with longer operative times (MD = 19.94 minutes [9.2, 30.68], P = 0.0003) but showed no significant difference in intraoperative blood loss. Postoperative Knee Society Scores were slightly higher in the RA-TKA group (MD = 1.03 [0.50, 1.57], P = 0.0002).

Conclusion: RA-TKA offers improved mechanical alignment accuracy compared to C-TKA but does not demonstrate superior short to medium-term functional outcomes. The technology is associated with longer operative times. These findings suggest that while RA-TKA may enhance surgical precision, its clinical benefits and cost-effectiveness require further evaluation, particularly in long-term studies.

Keywords: arthroplasty; conventional; knee; meta-analysis; robotic.

Figure 1.

PRISMA flow diagram of study selection process.

Figure 2.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: operative time (minutes).

Figure 3.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: intra-operative blood loss (ml).

Figure 4.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: change in WOMAC score. (A) Before resolving heterogeneity. (B) After resolving heterogeneity.

Figure 5.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: change in Oxford Knee Score (OKS).

Figure 6.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: mechanical alignment outlier rate. (A) Before resolving heterogeneity. (B) After resolving heterogeneity.

Figure 7.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: post-operative Knee Society Score (KSS).

Figure 8.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: post-operative Range of Motion (ROM).

Figure 9.

Forest plot of comparison: RA-TKA versus C-TKA, outcome: deviation from neutral mechanical axis.