Robotic assisted versus conventional total knee arthroplasty in obese patients: A systematic review and meta-analysis

Total knee arthroplasty (TKA) effectively treats advanced knee osteoarthritis, but obesity increases surgical complexity and complication risk. Robotic-assisted TKA (RA-TKA) may mitigate these challenges by enhancing surgical precision. To date, no study has compared robotic-assisted TKA with conventional total knee arthroplasty in obese patients. Therefore, we aimed to conduct such a comparison.

A systematic review and meta-analysis were performed in accordance with PRISMA 2020 guidelines. A comprehensive search of MEDLINE, Scopus, and Cochrane Central was performed from database inception to July 2025, to identify randomized controlled trials (RCTs) and observational studies with ≥3 months of follow-up, reporting at least one outcome of interest including operative time, complications rates, estimated blood loss (EBL), radiological alignment, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

A total of 5 studies comprising 979 obese patients were included. Of these, 561 patients (57.3 %) underwent C-TKA. The mean age in the RA-TKA group was 66.76 ± 2.28 years, with a mean BMI of 33.39 ± 3.49 kg/m². Operative time was significantly longer in patients undergoing RA-TKA compared with C-TKA (MD 12.14 min; CI 95 % 7.24 to 17.05; p = < 0.001). Postoperative hip-knee-ankle (HKA) alignment demonstrated significant difference with RA-TKA (MD -0.88°; CI 95 % -1.76 to -0.01; p = 0.05). Conversely, no significant differences were detected across the remaining clinical outcomes.

Our meta-analysis demonstrated that RA-TKA required significantly longer operative time compared with C-TKA, while other perioperative and functional outcomes remained comparable between both techniques.

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