Arthroplasty Outcomes After Robot-Assisted TKA: Does Radiographic Precision Translate Into Better Clinical Outcomes? A Systematic Review and Meta-analysis of Randomized Trials With ≥12-Month Follow-up

Background Robot-assisted total knee arthroplasty (TKA) improves radiographic precision, but whether this translates into clinically meaningful benefit remains uncertain. Methods We conducted a systematic review and meta-analysis of randomized comparative trials evaluating robot-assisted versus conventional manual TKA with at least 12 months of follow-up. PubMed/MEDLINE, Scopus, Web of Science, and CENTRAL were searched through August 2026. Random-effects meta-analyses were performed for knee-specific patient-reported outcome measures (PROMs), knee flexion/range of motion, and mechanical-axis alignment outliers. Sensitivity analyses assessed influential studies and methodological uncertainties. Results Seven studies met eligibility criteria. Four randomized trials comprising 1,773 participants contributed to the primary PROM analysis, which showed no significant advantage of robot-assisted TKA (Hedges’ g=0.06, 95% CI -0.01 to 0.13; P=0.066; I²=0%). Robot-assisted TKA reduced mechanical-axis alignment outliers (RR=0.50, 95% CI 0.41 to 0.62), with the effect preserved after sensitivity exclusion of the study with denominator inconsistency (RR=0.51, 95% CI 0.41 to 0.63). The pooled knee-motion estimate favored conventional TKA by 3.01° (95% CI - 4.41 to -1.60), but was dominated by one large trial. Operative time was generally longer with robotic assistance, while blood-loss and safety findings were inconsistent or insufficient for pooling. Conclusion Robot-assisted TKA provides greater radiographic precision but has not demonstrated superior patient-reported outcomes beyond 12 months. Longer-term randomized evidence is needed to determine whether improved technical accuracy translates into durable clinical or survivorship benefits.