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Robotic-Assisted Total Knee Arthroplasty in Complex Primary and Revision Cases: A Systematic Review
Emmanuel Olaonipekun1, Kourosh Movahedi2, Prushoth Vivekanantha3
1School of Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland. Emanola419@gmail.com.
Current Reviews in Musculoskeletal Medicine
|April 9, 2026
Summary
Robotic-assisted total knee arthroplasty (rTKA) offers improved coronal alignment in complex cases compared to conventional TKA (cTKA). While outcomes are comparable, robotic systems show advantages in severe deformities and revision surgeries.
Area of Science:
- Orthopedic Surgery
- Robotics in Medicine
- Arthroplasty Research
Background:
- Complex primary and revision total knee arthroplasty (TKA) presents unique surgical challenges.
- Accurate limb alignment is crucial for long-term TKA success and patient satisfaction.
Purpose of the Study:
- To systematically review and compare outcomes of robotic-assisted TKA (rTKA) versus conventional TKA (cTKA) in complex primary and revision cases.
- To assess coronal alignment, perioperative metrics, and patient-reported outcomes.
Main Methods:
- Systematic review of 19 studies involving 2,535 knees (1,931 rTKA, 604 cTKA).
- Analysis focused on complex cases: severe deformities, high BMI, fixed flexion, and revision arthroplasty.
- Outcomes included coronal alignment, complications, implant survival, and functional recovery.
Main Results:
- Robotic-assisted TKA consistently improved coronal alignment, especially in moderate-to-severe varus/valgus deformities.
- Revision rTKA achieved near-neutral alignment, low complications (4-17.9%), and high implant survival (97.1%).
- Robotic systems reduced soft tissue releases and facilitated early functional recovery; alignment precision improved in obese patients.
Conclusions:
- Robotic-assisted TKA reliably restores coronal alignment and yields comparable perioperative and patient-reported outcomes to conventional TKA in complex scenarios.
- Alignment benefits are most pronounced in severe deformities and challenging anatomy.
- Further prospective, randomized studies with long-term follow-up are needed to validate these findings.
