Efficacy of MAKO robot-assisted total knee arthroplasty compared with conventional total knee arthroplasty in patients with knee joint diseases: a systematic review and meta-analysis

Objective: To systematically evaluate the efficacy of MAKO robotic-arm assisted total knee arthroplasty (MAKO-TKA) in patients with knee diseases. Methods: We searched the CNKI, Wanfang, Vip, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of science database from inception to July 2026. We included comparative studies (non-randomized controlled studies) involving patients with knee disorders undergoing MAKO robot-assisted TKA (the experimental group received MAKO robot-assisted TKA, and the control group received conventional TKA). Data were analyzed using RevMan 5.2 software. Results: A total of nine studies involving 937 patients were included, comprising seven retrospective case-control studies and two before-and-after self-comparison studies. Meta-analysis showed that, compared with conventional TKA, the MAKO robot-assisted TKA group had a significantly smaller hip-knee-ankle (HKA) angle (MD = -0.96, 95% CI = -1.26 to -0.65, P < 0.0001) and significantly higher knee function scores (SMD = 0.46, 95% CI = 0.01 to 0.91, P = 0.04). Although pain scores tended to be lower in the MAKO group, the difference between the two groups was not statistically significant (SMD = -0.74, 95% CI = -1.55 to 0.06, P = 0.07). No statistically significant differences were observed in range of motion (ROM) (MD = 0.86, 95% CI = -0.23 to 1.94, P = 0.12) or Forgotten Joint Score (FJS) (SMD = 1.06, 95% CI = -0.15 to 2.27, P = 0.09). Subgroup analysis by follow-up duration revealed that, in the ≤6 months subgroup, MAKO robot-assisted TKA was associated with higher knee function scores (SMD = 6.40, 95% CI 0.48 to 12.32, P = 0.03); however, the test for subgroup differences did not reach statistical significance, indicating that follow-up duration could not be considered an explanatory factor for the heterogeneity observed in knee function scores. Conclusion: MAKO robot-assisted TKA showed statistically significant, standardized improvements in the HKA angle, and functional knee scores compared to conventional TKA. No conclusive advantage was found for ROM, pain or FJS. These findings support the prioritized use of this technology in cases demanding high precision, such as complex deformities, and highlight the need for standardized outcome measures in future prospective studies.