Robotic-assisted total knee arthroplasty: Promise or parity in long-term outcomes?

Introduction: The purpose of this systematic review of the literature was to evaluate long-term clinical and radiological outcomes, postoperative complications, and implant survivorship of robotic-assisted total knee arthroplasty (RA-TKA) compared to conventional manual total knee arthroplasty (Co-TKA).

Methods: A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Exclusively human studies comparing RA-TKA with Co-TKA, with at least 12-month follow-up, were included. Outcomes assessed included clinical and radiographic results, postoperative complications, and implant survivorship.

Results: Twenty-three articles met the inclusion criteria, mostly rated as level II or III evidence. RA-TKA was associated with improved component alignment, better knee balance, reduced blood loss, and soft tissue preservation. These findings were linked to lower postoperative pain and reduced opioid consumption. Regarding long-term outcomes, RA-TKA showed similar rates in post-operative complications compared to Co-TKA, though results varied across studies. Data on implant survivorship were limited, with most studies reporting comparable medium- and long-term survival rates between RA-TKA and Co-TKA.

Conclusion: Current evidence suggests RA-TKA offers superior short-term outcomes over conventional techniques, but long-term benefits, especially regarding complications and survivorship, are still uncertain. Additional long-term studies are essential to clarify the potential of RA-TKA in improving durability and patient outcomes in knee arthroplasty surgery.