Robotic-Assisted Knee Arthroplasty: Insights and Implications From Current Literature.

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Abstract

Conflict of interest statement: The authors have declared that no competing interests exist. 3. J Exp Orthop. 2025 Dec 2;12(4):e70452. doi: 10.1002/jeo2.70452. eCollection 2025 Oct. Robotic vs. conventional total knee arthroplasty over two decades: Evolving trends toward personalised alignment without significant clinical superiority in predominantly mild varus deformity-A systematic review of RCTs. Sacco R(1)(2), Tecame A(3), Lalevée M(1)(2), Perrier A(4)(5)(6), Massa E(7), Kouyoumdjian P(8)(9), Adravanti P(3). Author information: (1)Department of Orthopedic and Trauma Surgery Hôpital Charles Nicolle Rouen France. (2)CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations University of Rouen Normandy Mont-Saint-Aignan France. (3)Department of Orthopaedic and Trauma Surgery Città di Parma Clinic Parma Italy. (4)Univ. Grenoble Alpes, CNRS, TIMC Grenoble France. (5)Groupe Hospitalier Diaconesses-Croix Saint-Simon Paris France. (6)TwInsight Grenoble France. (7)Colchester General Hospital Colchester Essex UK. (8)Department of Orthopedic and Traumatological Surgery and Spine Surgery Hôpital Universitaire Carémeau Nîmes Cédex 9 France. (9)Mechanical and Civil Engineering Laboratory, UMR 5508 CNRS-UM CC 048 Montpellier 1 University Montpellier France. PURPOSE: Randomised controlled trials (RCTs) comparing robotic-assisted (RA-TKA) and conventional total knee arthroplasty (C-TKA) have demonstrated evolving trends in alignment strategies, surgical workflows and outcomes measurements. This review synthesises current evidence to clarify the evolving role of RA-TKA over the past two decades. METHODS: A PRISMA systematic review was conducted searching PubMed, Cochrane Library, and Google Scholar (2000-2024). Eligible studies were Level I RCTs comparing RA-TKA to C-TKA with well-defined alignment strategies and surgical workflows. Data included demographics, robotic and prosthetic systems, learning curves, outcome measures and complications. RESULTS: From 850 records, 9 RCTs were included (627 TKAs: 317 RA-TKA, 310 C-TKA). Patients averaged 66.9 years, BMI 28.1 kg/m², 27.9% male, 69.7 knees, follow-up 23.7 months. Coronal deformity was predominantly varus (