Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis. Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robot-assisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. METHODS: We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models. RESULTS: A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, −0.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups. CONCLUSIONS: Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.