Robot-Assisted Total Knee Arthroplasty: A Literature Review of Accuracy, Complications, Cost-Effectiveness, and Clinical Outcomes
Downloads
Background: Conventional Total Knee Arthroplasty (C-TKA) still faces challenges with high patient dissatisfaction rates, often linked to malalignment. Robot-Assisted TKA (RA-TKA) was developed to improve surgical precision. Despite its rapid adoption, there are conflicting findings regarding its advantages over C-TKA, along with concerns about cost and the learning curve. Objective: This literature review aims to comprehensively analyze and compare RA-TKA with C-TKA, focusing on four domains: (1) surgical accuracy and alignment; (2) complication rates; (3) cost-effectiveness; and (4) clinical outcomes. Findings: The review found that RA-TKA consistently demonstrates superior accuracy in restoring the mechanical axis (HKA) and coronal alignment, significantly reducing the number of outliers. RA-TKA also facilitates dynamic soft tissue balancing. However, findings regarding sagittal plane accuracy (e.g., tibial slope) remain contradictory across different robotic platforms. RA-TKA consistently requires longer operative times, especially during the learning curve, and introduces new technical risks such as pin failure and pin-site fractures. While the risk of major complications (e.g., PJI) is comparable, RA-TKA shows a lower risk of postoperative stiffness (arthrofibrosis). Evidence on mid-term revision rates remains inconclusive. Cost-effectiveness analysis shows that the high initial capital cost necessitates a very high procedural volume to achieve cost efficiency. Conclusion: RA-TKA offers clear advantages in coronal alignment precision but is offset by high costs, longer operative times, and specific robotic complications.
Baek, J. H., Lee, S. C., Lee, D. N., Heo, J., Kim, T., & Ahn, S. (2024). Better accuracy of robotic-assisted total knee arthroplasty compared to conventional technique in patients with failed high tibial osteotomy. PLOS ONE. https://doi.org/10.1371/journal.pone.0313391
Biswas, P., Sikander, S., & Kulkarni, P. (2023). Recent advances in robot-assisted surgical systems. Biomedical Engineering Advances, 6, 100109. https://doi.org/10.1016/j.bea.2023.100109
Burger, J., Fan, W., Gansiniec, S., Reinders, C., Kienzle, S., & Gwinner, C. (2025). Real-world outcomes of robotic total knee arthroplasty: Five years' experience in a non-academic center. [Journal name not provided in source], 1–12.
Canovas, F., & Dagneaux, L. (2018). Quality of life after total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research, 104(1), S41–S46. https://doi.org/10.1016/j.otsr.2017.04.017
Daoub, A., Qayum, K., Patel, R., Selim, A., & Banerjee, R. (2025). Robotic assisted versus conventional total knee arthroplasty: A systematic review and meta-analysis of randomised controlled trials. Journal of Robotic Surgery, 18(1), 1–10. https://doi.org/10.1007/s11701-024-02048-9
Ejnisman, L., Antonioli, E., Cintra, L., Souza, D. O., & Augusto, L. (2024). Robot-assisted knee arthroplasty: Analyzing the learning curve and initial institutional experience. Computational and Structural Biotechnology Journal, 24, 343–349. https://doi.org/10.1016/j.csbj.2024.04.013
Fan, X., Wang, Y., Zhang, S., Xing, Y., Li, J., & Ma, X. (2025). Orthopedic surgical robotic systems in knee arthroplasty: A comprehensive review. [Journal name not provided in source], 1–13.
Fan, X., Wang, Y., Zhang, S., Xing, Y., Li, J., & Ma, X. (2025). Orthopedic surgical robotic systems in knee arthroplasty: A comprehensive review. [Journal name not provided in source], 1–13.
García-Sanz, F., Sosa-Reina, M. D., Jaén-Crespo, G., González-de-la-Flor, Á., Villafañe, J. H., & Romero-Morales, C. (2025). Redefining knee arthroplasty: Does robotic assistance improve outcomes beyond alignment? An evidence-based umbrella review. [Journal name not provided in source], 1–14.
Geng, R., Li, J., Yu, C., Zhang, C., Chen, F., & Chen, J. (2023). Knee osteoarthritis: Current status and research progress in treatment (Review). [Journal name not provided in source], 1–11.
Goudazi, Z., Jafari, M., Kiyaei, A., Ravangard, R., Hashemi, S. A., & Keshavarz, K. (2025). Cost-effectiveness analysis of robotic-arm assisted total knee arthroplasty (TKA) versus conventional TKA in Iranian population. [Journal name not provided in source], 1–10.
Griffin, J., Davis, E. T., Parsons, H., Mannion, E. G., Khatri, C., & Ellard, D. R. (2023). Robotic arthroplasty clinical and cost effectiveness randomised controlled knee (RACER-knee): A study protocol. [Journal name not provided in source], 1–9.
Guo, J., Jin, Z., & Xia, M. (2025). Evaluating surgical outcomes: Robotic-assisted vs. conventional total knee arthroplasty. [Journal name not provided in source], 4.
Hasegawa, M., Tone, S., Naito, Y., & Sudo, A. (2024). Comparison of accuracy and early outcomes in robotic total knee arthroplasty using NAVIO and ROSA. Scientific Reports, 1–8. https://doi.org/10.1038/s41598-024-53789-4
Jevnikar, B. E., Khan, S. T., Emara, A. K., Elmenawi, K. A., Deren, M., & Piuzzi, N. S. (2025). Robotic total hip and knee arthroplasty: Economic impact and workflow efficiency. Journal of Robotic Surgery.
Kholinne, E., Gani, K. S., & Mitchel. (2025). Robotic-assisted total knee replacement: Pioneering precision and the future of joint reconstruction. Universa Medicina, 1–2.
León-Muñoz, V. J., & Moya-Angeler, J. (2025). Robotic assistance in total knee arthroplasty surgery: Necessity or trend? Expert Review of Medical Devices, 22(7), 653–656. https://doi.org/10.1080/17434440.2025.2512042
Liang, H., Hao, Y., & Yu, W. (2025). Comparing robot-assisted and conventional surgery in knee replacement: A meta-analysis of surgical-site wound complications and recovery outcomes. Asian Journal of Surgery, 48(2), 1027–1033. https://doi.org/10.1016/j.asjsur.2024.10.154
Mostafa, O., Malik, M., Qayum, K., Ishaq, U., & Tr, F. E. (2025). Robotic-assisted versus conventional total knee arthroplasty: A systematic review and meta-analysis of alignment accuracy and clinical outcomes. [Journal name not provided in source].
Nogalo, C., Meena, A., Abermann, E., & Fink, C. (2023). Complications and downsides of the robotic total knee arthroplasty: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 31(3), 736–750. https://doi.org/10.1007/s00167-022-07031-1
Pavlidis, G. (2023). Deploying artificial intelligence for anti-money laundering and asset recovery: the dawn of a new era. Journal of Money Laundering Control, 26(7), 155–166.
Petrillo, S., Migliorini, F., Moretti, G., & Romagnoli, S. (2025). Accuracy of ROSA knee system in bone cuts orientation during total knee arthroplasty: An observational study. [Journal name not provided in source], 1–9.
Rivero-Moreno, Y., Echevarria, S., Vidal-Valderrama, C., Pianetti, L., Cordova, J., & Navarro-Gonzalez, J. (2023). Robotic surgery: A comprehensive review of the literature and current trends. [Journal name not provided in source], 15(7).
Ruangsomboon, P., Ruangsomboon, O., Isaranuwatchai, W., Zywiel, M. G., & Naimark, D. M. (2025). Cost-effectiveness of robotic-assisted versus conventional total knee arthroplasty: An analysis from a middle income country. Acta Orthopaedica, 716–725.
Shin, C., Crovetti, C., Huo, E., & Lionberger, D. (2022). Unsatisfactory accuracy of recent robotic assisting system ROSA for total knee arthroplasty. [Journal name not provided in source].
Sittlington, S., & Harvey, J. (2018). Prevention of money laundering and the role of asset recovery. Crime, Law and Social Change, 70(4), 421–441.
Syarif, I., Warman, F. I., Sibarani, T., & Idulhaq, M. (2025). Complications of robotic assisted total knee arthroplasty vs manual total knee arthroplasty: A systematic review and meta-analysis. [Journal name not provided in source], XXVII, 1507–1516.
Varacallo, M. A., Luo, T. D., Mabrouk, A., & Johanson, N. A. (2025). Total knee arthroplasty techniques. [Journal name not provided in source], 1–15.
Xing, P., Qu, J., Feng, S., Guo, J., & Huang, T. (2024). Comparison of the efficacy of robot-assisted total knee arthroplasty in patients with knee osteoarthritis with varying severity deformity. [Journal name not provided in source].
Yi, J., Gao, Z., Huang, Y., Liu, Y., Zhang, Y., & Chai, W. (2024). Evaluating the accuracy of a new robotically assisted system in cadaveric total knee arthroplasty procedures. [Journal name not provided in source], 8, 1–10.
Zhang, H., Jiang, X., Jin, B., Zhang, H., & Liang, J. (2025). Current developments in robotic assistance technology for total knee arthroplasty: A comprehensive overview. Journal of Orthopaedic Surgery and Research. https://doi.org/10.1186/s13018-025-05490-z
Copyright (c) 2026 Deria Zahra Fatihah, Juniarto Jaya Pangestu, Norman Zainal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
