Early clinical benefits of robot-assisted versus manual total knee arthroplasty: A randomized controlled trial

Total knee arthroplasty (TKA) is effective for treating advanced symptomatic osteoarthritis. Despite its success, up to 20% of patients express dissatisfaction due to unmet expectations, pain, or limited functional gains. Robotic-assisted TKA improves surgical accuracy and may enhance patient outcomes, but its advantages over conventional manual TKA (mTKA) remain uncertain.

This was a prospective, randomized, single-center trial comparing early outcomes of robotic-assisted TKA with the Robotic Surgical Assistant (ROSA) Knee System (rTKA), versus mTKA. Sixty-eight patients were randomized to rTKA (n = 34) or mTKA (n = 34). Blood loss, operative time, range of motion, mechanical alignment, and patient-reported outcomes (pain, KOOS and SF-36 scores) were analyzed.

rTKA procedures were on average 9 min longer than mTKA (P = 0.003). rTKA was associated with reduced perioperative blood loss (P = 0.019), greater flexion (122.8° vs. 114.7°, P = 0.006), and more accurate alignment (1° vs. 2°, P = 0.002). At 3 months, pain scores were lower with rTKA (VAS 1.0 vs. 2.0, P = 0.012). Both groups improved significantly in KOOS and SF-36, with social functioning favoring rTKA (P = 0.039). No complications, adverse events, revisions, or conversions to mTKA occurred.

rTKA was safe and showed short-term advantages, including greater knee flexion, reduced blood loss, more accurate alignment, and improved pain and social functioning. These early benefits support the potential of rTKA to optimize TKA outcomes. Long-term studies are needed to assess whether these persist and translate into improved implant longevity and enhance patient satisfaction following TKA.