Robotic-assisted versus conventional total knee arthroplasty: an updated systematic review and meta-analysis of randomised controlled trials with grade assessment
Journal of Orthopaedic Surgery and Research · 9 Sept 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
RTKA is being rapidly adopted based on the promise of better alignment, so trainees should know that improved radiographic precision has not yet reliably translated into better patient-reported outcomes.
The evidence
This is a meta-analysis of 31 randomised trials (4086 patients) comparing robotic-assisted total knee arthroplasty (RTKA) to conventional TKA. RTKA modestly improved several radiographic alignment measures, most notably reducing hip-knee-ankle deviation by 0.83 degrees and cutting the rate of alignment outliers roughly in half, but patient-reported function, pain, biomarkers, blood loss, hospital stay, and overall complications were largely similar between groups, while robotic surgery took about 21 minutes longer on average.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Meta-analysis of RCTsDesign starting point: 60.8
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
- No correction for multiple comparisons−3.4
Methods at a glance
Recorded assessment- Comprehensive literature searchNot reported
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedMet
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 60.8
- Compared against current standard of care
- +3.4
- 0% loss to follow-up
- +1.7
- Prospectively registered
- +5.1
- No correction for multiple comparisons
- −3.4
- Pools randomised trials
- +5.1
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Publication bias assessed
- +2.5
- Final rigour score rounded
- 83 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If radiographic alignment improves with robotic assistance but patient-reported function does not, how should this change how you counsel patients about choosing RTKA versus conventional TKA?
2.Given that RTKA adds about 20 minutes of operative time without clear functional benefit, how should surgeon experience, case complexity, and institutional resources factor into deciding which patients are best suited for robotic assistance?
Original publication title
Robotic-assisted versus conventional total knee arthroplasty: an updated systematic review and meta-analysis of randomized controlled trials with grade assessment