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Review
. 2026 Feb 26;38(1):10.
doi: 10.1186/s43019-026-00311-x.

Comparative analysis of revision causes between robotic-assisted and conventional manual unicompartmental knee arthroplasty: a systematic review and meta-analysis

Pengyu Xiang #  1   2 , Hongfu Jin #  3 , Yiming Dai  1   2 , Yixin Yang  4 , Chenhao Jia  1   2 , Lather Sagar  1   2 , Jian Zhang  5 , Yungang Wu  2   6 , Chunwu Zhang  2   6 , Shengwu Yang  7   8 , Zhenhan Deng  9   10
Affiliations
Review

Comparative analysis of revision causes between robotic-assisted and conventional manual unicompartmental knee arthroplasty: a systematic review and meta-analysis

Pengyu Xiang et al. Knee Surg Relat Res. .

Abstract

Background: Robotic-assisted unicompartmental knee arthroplasty (R-UKA) is an emerging procedure; however, its benefits over conventional manual unicompartmental knee arthroplasty (C-UKA) are controversial, especially the revision and failure rates, and existing studies failed to reach a consensus on this issue.

Methods: The literature search was conducted on four databases (PubMed, Embase, Cochrane Library and Web of Science) from inception to 28 April 2025 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Eligibility criteria were studies that were written in English and reported any causes for a revision or failure subsequent to UKA with comparisons between R-UKA and C-UKA. The quality of each article was assessed using the Cochrane collaboration risk of bias tool or the Newcastle-Ottawa Scale.

Results: A total of 15 studies incorporating 29,982 patients with 30,099 knees (22,290 in the C-UKA group and 7809 in the R-UKA group) were analyzed. Compared with R-UKA, C-UKA showed higher total revision rates (RR: 1.58; 95% CI: ~1.33-1.87; P < 0.00001; I2 = 43%). Prosthesis loosening, infection, pain, and progression of disease were the main reasons for R-UKA revision, whereas for C-UKA revision, loosening, progression of disease, infection, and limb malalignment were the major causes. Loosening was the predominant reason in both groups across all follow-up periods; early revisions were also due to infection and disease progression. Within 2-5 years, the secondary reasons differed, being limb malalignment for C-UKA and pain for R-UKA.

Conclusions: Compared with C-UKA, R-UKA may lower the risk of revision related to loosening, disease progression, and limb malalignment. Loosening remains the primary revision cause for both. Large-scale prospective trials with unified technical details are warranted to draw more rigorous conclusions in the future.

Trial registration: PROSPERO CRD420251042604.

Keywords: Meta-analysis; Revision; Robot; Systematic review; Unicompartmental knee arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of literature screening
Fig. 2
Fig. 2
A Sensitivity analysis of the included studies. B Funnel plot of the included studies
Fig. 3
Fig. 3
Forest plot of total revision
Fig. 4
Fig. 4
Forest plot of total revision stratified by follow-up period. A Follow-up period ≤ 2 years. B Follow-up between 2 and 5 years. C Follow-up period > 5 years
Fig. 5
Fig. 5
A Forest plot of revision caused by loosening. B Forest plot of revision caused by progression of disease. C Forest plot of revision caused by pain. D Forest plot of revision caused by infection. E Forest plot of revision caused by limb malalignment
See this image and copyright information in PMC

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