Abstract
<title>Abstract</title> <p>Background Robotic-assisted total knee arthroplasty (RA-TKA) aims to enhance surgical precision and address the 20% patient dissatisfaction rate associated with conventional manual TKA (CM-TKA). This meta-analysis evaluates the comparative effectiveness of RA-TKA versus CM-TKA. Methods Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, and the Cochrane Library identified eligible randomized controlled trials (RCTs) and observational studies (January 2021–December 2025) comparing primary RA-TKA against CM-TKA. Quality was assessed using RoB 2.0 and the Newcastle-Ottawa Scale. Statistical synthesis utilized Review Manager to calculate mean differences (MD) and 95% confidence intervals. This study was pre-registered at PROSPERO (Registration number: CRD420261442305). Results Twelve studies (six RCTs, six observational studies) were included. RA-TKA was associated with significantly longer operative time than CM-TKA (MD = 15.81 minutes, P = 0.0001), with no significant difference in blood loss (P = 0.24). Radiographically, RA-TKA achieved significantly better overall postoperative alignment (MD = 0.54 degrees, P = 0.0006). Clinically, RA-TKA yielded greater postoperative knee range of motion (MD = 3.94 degrees, P < 0.00001) and significantly better WOMAC Functional scores (MD = -4.61, P = 0.008). However, no statistically significant differences existed between cohorts for KSS, KOOS JR, or the WOMAC Pain and Stiffness subscales (P ≥ 0.16). Conclusion RA-TKA provides superior radiographic precision, greater postoperative range of motion, and better WOMAC functional scores compared to CM-TKA. However, these technical advantages do not consistently translate into superior outcomes across all patient-reported measures at short- to medium-term follow-up.</p>