Robot-assisted total vs. unicompartmental knee arthroplasty: A systematic review and meta-analysis

Robot-assisted (RA) surgeries are a major advancement in the medical field, allowing surgeons to operate remotely with minimal direct involvement. Over the past decade, robotic systems have been increasingly used in many areas, including orthopedic procedures. This systematic review and meta-analysis aimed to evaluate the effectiveness of RA-total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (RA-UKA).

A systematic review and meta-analysis of 12 randomized controlled trials was conducted to compare total and unicompartmental RA-TKA with each other and with the conventional method. A total of 1.538 participants were included in the studies, which were published between January 2014 and November 2024. The main outcomes of interest were range of motion (ROM) and pain measured by the visual analogue scale (VAS). The Cochrane RoB2 tool was used to assess the risk of bias. Subgroup analyses were carried out for RA-TKA and RA-UKA outcomes. Prospero Registration: CRD42024627463.

RA knee arthroplasty and conventional knee arthroplasty showed no significant differences in either outcome ROM or VAS score for pain with results of [MD =2.30, 95% CI: -1.56 to 6.16] and (MD =0.05, 95% CI: -0.14 to 0.23), respectively. Similarly, the comparison between RA-TKA and RA-UKA in the subgroup analysis also showed no significant difference, with combined results of (MD =2.30, 95% CI: -1.56 to 6.16) and (MD =0.05, 95% CI: -0.14 to 0.23), respectively.

RA knee arthroplasties (RA-TKA and RA-UKA) show similar outcomes to each other and to conventional methods in terms of ROM and pain reduction (VAS), with both robotic techniques showing comparable alternatives to traditional methods. These techniques also offer advantages such as greater precision and less direct involvement from the surgeon, which may help reduce human error. RA-TKA and RA-UKA produce similar results, and either can be used depending on the patient's knee condition and availability of experienced surgeons in robotics. Future studies with standardized protocols, larger sample sizes, and longer follow-up periods are needed to better understand and confirm the long-term benefits and differences between RA-TKA and RA-UKA techniques.