First Clinical Experience with Robotic-Assisted Total Knee Arthroplasty in Indonesia: Early Results and Comparison with Global Evidence

Background: Robotic-assisted total knee arthroplasty (TKA) has emerged as a precision-enhancing alternative to conventional TKA, yet real-world evidence from low- and middle-income settings remains limited. Objective: This study compares perioperative, radiographic, and early functional outcomes between robotic-assisted and conventional TKA in a tertiary care cohort. Methods: A retrospective comparative study was conducted at Jinnah Postgraduate Medical Center from May 2023 to May 2024 on 138 patients who underwent primary TKA. Patients were assigned to either robotic-assisted (n = 69) or conventional TKA (n = 69) based on operative technique. Demographics, intraoperative parameters, radiographic alignment, postoperative recovery, complications, and 6-month functional outcomes (WOMAC, KSS, satisfaction) were compared. Results: Baseline characteristics were comparable between groups. Robotic TKA had longer operative time (102.6 ± 12.8 vs. 94.2 ± 11.3 min; p < 0.001) but lower blood loss (172 ± 41 vs. 222 ± 58 mL; p < 0.001) and fewer soft-tissue releases (11.6% vs. 27.5%; p = 0.018). Alignment within ±3° of neutral was achieved more frequently in the robotic group (91.3% vs. 72.5%; p = 0.006). Early ambulation (<24 h) and shorter length of stay were more common after robotic TKA (76.8% vs. 58.0%; p = 0.019 and 3.2 ± 0.9 vs. 4.1 ± 1.1 days; p < 0.001, respectively). Six-month WOMAC and KSS scores were significantly better in the robotic group (p = 0.002 and p = 0.001). Conclusion: Robotic-assisted TKA demonstrated superior radiographic precision and improved early recovery and functional outcomes compared to conventional TKA, despite longer operative time. Prospective studies with long-term follow-up and cost-analysis are warranted to define durability and feasibility of broader implementation in resource-limited healthcare systems.

The study aims to provide an up-to-date systematic review and meta-analysis comparing radiological and functional outcomes of total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) using either robotic assistance or conventional methods from the latest assemblage of evidence. This study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. All studies in PubMed, EMBASE, Medline, and Cochrane that reported radiological and functional outcomes after TKA or UKA with either robotic or conventional methods were included in the review. Selected endpoints for random effects, pairwise meta-analysis included operative details, radiological outcomes (mechanical axis, component angle deviation, and outliers), and functional outcomes (American Knee Society Score, Knee Society Function Score, revision and complication rate, range of motion (ROM), Hospital for Special Surgery score, and Western Ontario and McMaster Universities Osteoarthritis Index). A total of 23 studies comprising 2,765 knees were included from the initial search. Robot-assisted TKA and UKA were associated with significantly better component angle alignment accuracy (low-to-high quality evidence) at the cost of significantly greater operation time. Robot-assisted UKA was found to have significantly better short-term functional outcomes compared with conventional UKA (moderate-to-high quality evidence). Robot-assisted TKA, however, did not exhibit significantly better short- and midterm subjective knee outcome scores compared with its conventional counterpart (high-quality evidence). Robot-assisted TKA and UKA were associated with nonstatistically significant improved ROM and lesser rates of revision. Robot-assisted total and unicompartmental knee arthroplasty leads to better radiological outcomes, with no significant differences in mid- and long-term functional outcomes compared with conventional methods for the former. Larger prospective studies with mid- and long-term outcomes are required to further substantiate findings from the present study.

IntroductionAccurate sizing of femoral and tibial components is fundamental to achieving successful outcomes in total knee arthroplasty (TKA). Oversizing can increase patellofemoral contact forces and restrict flexion, whilst undersizing may result in instability. Although conventional TKA is well established, robotic-assisted systems provide enhanced alignment accuracy, individualised planning, and reduced periarticular soft-tissue injury. Bilateral TKA is increasingly performed in Middle Eastern populations, where knee anthropometry differs from Western cohorts. Previous studies in conventional bilateral TKA have demonstrated notable asymmetry between femoral and tibial components. The aim of this study was to determine the frequency of component asymmetry in simultaneous bilateral robotic-assisted TKA using the Navio robotic system in a Middle Eastern population.MethodsA retrospective review was undertaken of all patients undergoing primary, uncomplicated simultaneous bilateral robotic-assisted TKA at Mediclinic City Hospital, Dubai, UAE, between January 2018 and January 2020. Only procedures performed by a single surgeon were included. Demographic data, body mass index (BMI), and component sizes were recorded. All procedures utilised implants from the Anthem Total Knee System (Smith & Nephew, London, UK), designed with standard and narrow femoral options to minimise medio-lateral overhang. Symmetry of femoral, tibial, polyethylene, and patellar components was assessed. Standard perioperative protocols for infection prevention, thromboprophylaxis, and enhanced recovery rehabilitation were employed.ResultsA total of 140 patients (78.6% female patients, mean age 70.4 ± 8.8 years) were included. The mean BMI fell within the overweight to obese range. Femoral components were identical in 132 patients (95%), with asymmetry present in eight patients (5%). Of these, six patients (4%) demonstrated a one-size difference, and eight exhibited variation in femoral component width (standard versus narrow). All tibial baseplates, polyethylene inserts, and patellar components were symmetrical across both knees (100%).ConclusionThis is the largest series to date reporting on component symmetry in robotic-assisted bilateral TKA in a Middle Eastern population. The findings demonstrate a high degree of femoral and tibial component symmetry, with only 5% of patients requiring femoral asymmetry and none requiring tibial or patellar asymmetry. Compared with prior reports of conventional bilateral TKA in similar populations, robotic-assisted TKA showed markedly lower asymmetry rates. These results suggest that robotic technology improves the accuracy of component sizing and alignment, reduces mismatch rates, and may enhance long-term functional outcomes. Further prospective studies with functional and radiological endpoints are recommended to corroborate these findings and explore cost-effectiveness in the wider clinical practice.

Robotic assisted total knee arthroplasty (RTKA) has shown improved knee alignment and reduced radiographic outliers. However, there remains debate on functional outcomes and patient-reported outcomes (PROMs). This study compares the 1-year clinical outcomes of a new imageless robotically assisted technique (ROSA Knee System, Zimmer Biomet, Warsaw, IN) with an imageless navigated procedure (NTKA, iAssist Knee, Zimmer, Warsaw, IN). The study is a retrospective analysis of prospectively collected data that compared the functional outcomes and PROMs of 50 imageless RTKA with 47 imageless NTKA at 1-year follow-up. Baseline characteristics, intraoperative and postoperative information were collected including complications, revisions, Knee Society Score (KSS), Knee injury and Osteoarthritis Outcome Score (KOOS) score, and Forgotten Joint Score (FJS-12). Radiographic analysis of preoperative and postoperative images evaluating hip-knee-ankle (HKA) angle was performed. There was no difference regarding baseline characteristics between the groups. Mean operative time was significantly longer in the RTKA group (122min vs. 97min; p < 0.0001). Significant differences were reported for the "Pain" (85 [RTKA] vs 79.1 [NTKA]; p = 0.0283) subsection of the KOOS score. In addition, RTKA was associated with higher maximum range of motion (119.4° vs. 107.1°; p < 0.0001) and better mean improvement of the arc of motion by 11.67° (23.02° vs. 11.36°; p < 0.0001). No significant differences were noted for other subsections of KOOS, KSS, FJS-12, complications, or limb alignment at 1-year follow-up. Imageless RTKA was associated with longer surgical time, better pain perception and improved ROM at 12-month follow-up compared with NTKA. No significant differences were reported on other PROMs, complication rates and radiographic outcomes. III.

Robotic-assisted total knee arthroplasty (RA-TKA) aims to improve surgical accuracy and reduce soft-tissue trauma. The bone-milling technique may further decrease mechanical stress during bone preparation. This study primarily compared systemic inflammatory biomarkers between bone-milling RA-TKA and conventional TKA (C-TKA), with secondary assessments of perioperative parameters, radiographic alignment, and early postoperative outcomes. This prospective randomized controlled trial included 30 RA-TKAs and 30 C-TKAs performed between August 2023 and December 2024 in patients with Kellgren-Lawrence grade IV knee osteoarthritis. All RA-TKA procedures were conducted during the operating surgeon's early learning phase with the robotic platform. Serum interleukin (IL)-6, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), creatine kinase (CK), and lactate dehydrogenase (LDH) were measured preoperatively and at 6h, 1day, 3days, 2weeks, and 6weeks postoperatively. Perioperative variables, radiographic alignment, and 6-week Knee Society Score (KSS) and visual analog scale (VAS) pain scores were compared. Postoperative inflammatory biomarkers did not differ significantly between groups at any time point, and the corresponding effect sizes were small, indicating minimal biological differences. Estimated blood loss was comparable (p = 0.753). RA-TKA demonstrated significantly improved postoperative mechanical alignment (mechanical axis [MA] deviation: 0.3 ± 2.4° versus 2.8 ± 3.4°; p = 0.002) but required longer tourniquet times (121.4 ± 15.3min versus 95.0 ± 13.3min; p < 0.001). Early functional outcomes were similar, with no significant differences in KSS (p = 0.114) or VAS pain scores at 6weeks (p = 0.508). Bone-milling RA-TKA did not reduce systemic inflammatory responses compared with C-TKA, with small effect sizes confirming minimal biological differences. However, it provided superior radiographic alignment, while perioperative parameters and early postoperative recovery remained comparable except for longer tourniquet time.

Robotic-assisted TKA continues to see wider clinical use, despite limited knowledge of its impact on patient satisfaction and implant survival. Most studies to date have presented small cohorts and came from single-surgeon or single-center experiences. Therefore, a population-level comparison of revision rates between robotic-assisted and conventional TKA in the registry setting may help arthroplasty surgeons better define whether robotic assistance provides a meaningful advantage compared with the conventional technique. (1) After controlling for confounding variables, such as surgeon, location of surgery, and patient comorbidity profile, were robotic-assisted TKAs less likely than conventional TKAs to result in revision for any reason at 2 years? (2) After again controlling for confounding variables, were robotic-assisted TKAs less likely to result in any specific reasons for revision than the conventional technique at 2 years? The American Joint Replacement Registry was used to identify patients 65 years or older who underwent TKA between January 2017 and March 2020 with a minimum of 2 years of follow-up. Patients were limited to age 65 yeas or older to link TKAs to Medicare claims data. Two retrospective cohorts were created: robotic-assisted TKA and conventional TKA. Patient demographic variables included in the analysis were age, gender, BMI, and race. Additional characteristics included the Charlson comorbidity index, anesthesia type, year of the index procedure, and length of stay. A total of 10% (14,216 of 142,550) of TKAs performed during this study period used robotics. Patients with robotic-assisted TKA and those with conventional TKA were similar regarding age (73 ± 6 years versus 73 ± 6 years; p = 0.31) and gender (62% [8736 of 14,126] versus 62% [79,399 of 128,334] women; p = 0.34). A multivariable, mixed-effects logistic regression model was created to analyze the odds of all-cause revision as a factor of robot use, and a logistic regression model was created to investigate specific revision diagnoses. After controlling for potentially confounding variables, such as surgeon, location of surgery, and Charlson comorbidity index, we found no difference between the robotic-assisted and conventional TKAs in terms of the odds of revision at 2 years (OR of robotic-assisted versus conventional TKA 1.0 [95% CI 0.8 to 1.3]; p = 0.92). The reasons for revision of robotic-assisted TKA did not differ from those of conventional TKA, except for an increased odds of instability (OR 1.6 [95% CI 1.0 to 2.4]; p = 0.04) and pain (OR 2.1 [95% CI 1.4 to 3.0]; p < 0.001) in the robotic-assisted cohort. In light of these findings, surgeons should not assume that robotic assistance in TKA will lead to improved early implant survival. Our findings do not support an improvement over conventional TKA with robotic assistance with regards to common causes of early revisions such malalignment, malposition, stiffness, pain, and instability, and in some cases, suggest there is a benefit to conventional TKA. Differences in the mid-term and long-term revision risk with conventional versus robotic-assisted TKA remain unknown. Appropriate informed consent around the use of robotic assistance should not imply decreased early revision risk. Level III, therapeutic study.

Under functional knee positioning (FKPos) principles, residual varus or valgus alignment of the tibia and femur may be maintained, resulting in loading conditions that differ from those observed with mechanical alignment. Consequently, there is a need for evidence regarding implant fixation (cemented or cementless) in this context. This study aimed to evaluate the impact of implant fixation type (cemented versus cementless) on clinical outcomes, complications, and implant survival in robotic-assisted total knee arthroplasty (TKA) guided by FKPos principles. A retrospective comparative analysis of 393 patients who underwent robotic-assisted primary TKA was performed. Patients were divided into two groups: cemented (n=85) and cementless (n=276) fixation. Radiographic alignment, functional outcomes using the Knee Society Score (KSS) and Forgotten Joint Score (FJS), complication rates, and implant survival were assessed at a minimum 2-year follow-up. Subgroup analyses based on femoral and tibial fixation types were also conducted. Both fixation methods achieved comparable functional outcomes (KSS and FJS) and implant survivorship, with no significant differences in revision rates. Hematomas were significantly more frequent in the cementless group (12.32% vs. 8.24%, p=0.02). Subgroup analyses of femoral and tibial implants showed no significant differences in functional outcomes. This study is the first to assess the influence of fixation type on outcomes in robotic-assisted TKA performed under FKPos principles. Both cemented and cementless fixation methods are safe and effective.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment - A prospective randomized and multicenter study.

Background: Total knee arthroplasty (TKA) effectively relieves pain in end-stage osteoarthritis, yet a proportion of patients remain dissatisfied despite advances in surgical technique. Medial-congruent (MC) bearings are designed to recreate native medial-pivot kinematics, which depend on appropriate medial compartment soft tissue tension. Robotic-assisted TKA (RA-TKA) has been shown to improve the accuracy and soft tissue balance. However, evidence of its additional benefits in MC TKA remains limited. Methods: We retrospectively identified consecutive primary TKAs with the same MC bearing performed between April 2022 and June 2024 at a tertiary center. After performing 1:1 propensity score matching to reduce baseline imbalance, 36 patients who received RA-TKA and 36 who underwent manual TKA (M-TKA) were included. Primary outcomes were evaluated with the 12-month Oxford Knee Score (OKS) and KOOS-JR. Secondary outcomes included radiographic alignment parameters, outlier rates, operative time, liner thickness, and hospital stay. Results: Baseline characteristics and liner thickness were comparable, and operative time was longer in the RA-TKA group than in the M-TKA group. Both RA-TKA and M-TKA produced significant 12-month improvements in OKS and KOOS-JR with no difference in mean scores. RA-TKA had fewer posterior tibial slope outliers (mean slope 4.3° ± 1.8 vs. 5.9° ± 3.1; outlier rate 16.7% vs. 41.7%; p = 0.02), whereas coronal alignment parameters did not differ between groups. Conclusions: RA-TKA with MC bearing provides functional outcomes comparable to M-TKA and may decrease sagittal alignment variability; long-term follow-up studies are needed to determine whether this potential benefit translates into sustained functional gains or improved implant survivorship.

Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better surgical accuracy. However, its impact on patient outcomes is uncertain. The aim of this systematic review of randomized controlled trials (RCTs) is to evaluate whether RATKA could improve functional and radiological outcomes compared with COTKA in adult patients with primary osteoarthritis of the knee. We searched Ovid MEDLINE, EMBASE, Scopus, and the Cochrane Library to identify published RCTs comparing RATKA with COTKA. 2 reviewers independently screened eligible studies, reviewed the full texts, assessed risk of bias using the Risk of Bias 2.0 tool, and extracted data. Outcomes were patient-reported outcomes, range of motion, and mechanical alignment (MA) deviation and outliers, and complications. We included 12 RCTs involving 2,200 patients. RATKA probably results in little to no effect on patient-reported outcomes (mean difference (MD) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of -0.35 (95% confidence interval [CI] -0.78 to 0.07) and range of motion (MD -0.73°; CI -7.5° to 6.0°) compared with COTKA. However, RATKA likely results in a lower degree of MA outliers (risk ratio 0.43; CI 0.27 to 0.67) and less deviation from neutral MA (MD -0.94°; CI -1.1° to -0.73°). There were no differences in revision rate or major adverse effects associated with RATKA. Although RATKA likely results in higher radiologic accuracy than COTKA, this may not be clinically meaningful. Also, there is probably no clinically important difference in clinical outcomes between RATKA and COTKA, while it is as yet inconclusive regarding the revision and complication rates due to insufficient evidence.

Robotic-assisted TKA may allow for more reproducible balancing and implant positioning. However, few RCTs have directly compared modern robotic-assisted TKA to conventional TKA. (1) Do patients undergoing robotic-assisted TKA perform better on the Timed Up and Go (TUG) test and Stair Climb test (SCT) than patients undergoing conventional TKA at 1 and 6 months after surgery? (2) Do patients undergoing robotic-assisted TKA demonstrate better patient-reported outcomes, including Knee Injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, and VAS scores, than patients undergoing conventional TKA at 1 and 6 months after surgery? (3) Do patients undergoing robotic-assisted TKA demonstrate better radiographic alignment and position than patients undergoing conventional TKA? In this double-blind RCT, 60 patients were randomized to robotic-assisted TKA (n = 30) or conventional TKA (n = 30) without the use of a tensioning device. All care was otherwise standardized, using mechanical alignment guides. The primary outcome measures were the TUG and SCT tests; results were collected by a blinded observer at 6 months postoperatively. These time points were chosen based on the maximal early improvement in patient-reported outcomes and bimodal distribution of the TUG and SCT tests, worsening in the immediate postoperative period, and improving within the first 6 months. Secondary outcome measures were KOOS, EQ-5D, and VAS scores; radiographic measurements; and operative time. Standard bivariate statistical analysis was conducted. The mean ± SD age of the cohort was 66 ± 7 years, with no differences between groups (p = 0.21). Ninety-three percent (28 of 30) of patients in the robotic-assisted group were White versus 97% (29 of 30) in the conventional TKA group (p > 0.99). Women made up 57% (17) of the robotic-assisted cohort and 60% (18) of the conventional TKA cohort. No differences were noted between the robotic-assisted and conventional TKA groups in BMI, Charlson comorbidity index, or American Society of Anesthesiologists (ASA) classification. Patients undergoing robotic-assisted TKA did not perform better than those who underwent conventional TKA on the TUG (11 versus 11 seconds; p = 0.88) or SCT (15 versus 15 seconds; p = 0.93) tests. Patients undergoing robotic-assisted TKA did not demonstrate better mean ± SD scores on the KOOS pain subscale than patients undergoing conventional TKA (86 ± 14 versus 80 ± 17; p = 0.15). Patients undergoing robotic-assisted TKA did not demonstrate better radiographic alignment and position than patients undergoing conventional TKA based on hip-knee-ankle angle (178° versus 178°; p = 0.89). No differences between the two groups were noted at the 1-month follow-up in TUG and SCT test results. In this study, patients who underwent robotically assisted TKA did no better in terms of function, patient-reported outcomes, or radiographic measures than did patients who underwent conventional TKA. Until or unless future studies demonstrate benefits of robotically assisted TKA that are large enough for patients to perceive, we recommend against its use. Level I, therapeutic study.

This study compares postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) versus navigation-guided total knee arthroplasty (NG-TKA). Using Nationwide Inpatient Sample (NIS) data, it provides an analysis of postoperative complications, mortality, hospital costs and duration of stay. The study analysed 217,715 patients (81,830 RA-TKA; 135,885 NG-TKA) using NIS data from 2016 to 2019. Elective TKA patients were identified through the International Classification of Diseases, 10th Revision codes. Statistical analyses, including logistic regression modelling, were performed using Statistical Package for the Social Sciences and MATLAB. RA-TKA patients were younger (66.1 vs. 67.1 years, p < 0.0001) and had similar mortality rates (0.024% vs. 0.018%, p = 0.342) but shorter length of stay (LOS) (1.89 vs. 2.1 days, p < 0.0001). Mean total charges were comparable between RA-TKA ($66,180) and NG-TKA ($66,251, p = 0.669). RA-TKA demonstrated lower incidences of blood-related complications (11.67% vs. 14.19%, p < 0.0001), pulmonary oedema (0.0306% vs. 0.066%, p < 0.0001), deep vein thrombosis (0.196% vs. 0.254%, p = 0.006) and acute kidney injury (AKI) (1.356% vs. 1.483%, p = 0.016). RA-TKA reduces postoperative complications and LOS without increasing costs, highlighting the relevance of this technology in patient care. Level III.

Background: Total knee arthroplasty (TKA) is the treatment of choice in severe osteoarthritis (OA) knee. Robot-assisted TKA (RA-TKA) promises superior precision and personalized bone resection and alignment, whereas conventional TKA (C-TKA) relies on manual alignment techniques. This randomized controlled trial compares alignment accuracy and short-term functional outcomes between the two modalities. Methods: 100 patients with bilateral knee OA were randomized to RA-TKA (n=50) or C-TKA (n=50). Postoperative mechanical alignment (hip-knee-ankle (HKA) angle) and functional outcomes (new knee society score (NKSS) and forgotten joint score (FJS)) were assessed at 6 months. Results: RA-TKA achieved significantly better alignment, with 82% of patients within±3° of the target HKA angle compared to 64% in C-TKA (p&lt;0.01). However, functional outcomes were comparable: KSS (RA-TKA: 205.42±6.52 vs. C-TKA: 205.4±7.94, p=0.989) and FJS (RA-TKA: 88.6±4.07 vs. C-TKA: 88.92±4.16, p=0.662). Conclusions: RA-TKA offers improved alignment accuracy over C-TKA but does not confer superior short-term functional outcomes. Despite achieving more precise mechanical alignment, no significant differences in key functional scores are observed within six months postoperatively. The potential long-term benefits of this improved alignment, such as increased implant longevity or reduced wear, remain unconfirmed and warrant further investigation in studies with extended follow-up.

To systematically evaluate and re-evaluate the surgical outcomes of robotic-assisted total knee arthroplasty(RA-TKA) compared with to conventional total knee arthroplasty(C-TKA). Ten databases, including PubMed, EmBase, Web of Science, Cochrane Library, CINAHL, JBI, CNKI, Wanfang, VIP, CBM, were comprehensively searched from inception to September 2024. Eligible studies included systematic reviews and meta-analysis comparing the surgical outcomes of RA-TKA and C-TKA. Two independen researchers performed data extraction and quality assessment. Methodological quality was evaluated using the AMSTAR tool, while the certainty of evidence was graded using GRADE system. The degree of overlap among primary studies included in the systematic reviews/meta-analyses was investigated using the corrected covered area (CCA). A total of 15 systematic reviews/Meta-analyses were included, 5 were rateak as high quality, 1 as moderate quality, and 9 as low quality. A total of 53 pieces of evidence were identified, 11 pieces of evidence were of high quality, 19 were of moderate quality, 16 were of low quality, and 7 were of very low quality. Ten studies assessed the Knee Society score(KSS) and performed a meta-analysis. Among these, seven studies reported that there was no statistically significant difference in postoperative KSS scores between the two surgical methods. Nine studies evaluated the Hospital for Special Surgery(HSS) score, with seven indicating no statistically significant difference in HSS scores following surgery. Twelve studies examined the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score postoperatively, and five found no significant difference between the two surgical approaches. Five studies compared the hip-knee-ankle (HKA) angle deviation between the two groups, all of which demonstrated that the HKA angle deviation in RA-TKA was significantly lower than in C-TKA. Eight studies reported on the range of motion (ROM) of the knee joint after surgery, with six showing no statistically significant difference between the two methods. Finally, nine studies compared the duration of the surgical procedures, all of which concluded that RA-TKA required a longer operative time than C-TKA. With regard to functional outcomes, no statistically significant difference was observed between RA-TKA and C-TKA. Nevertheless, RA-TKA demonstrates advantages in terms of surgical accuracy, precision, and alignment correction.

Background: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.