Total knee arthroplasty: use of robotic surgery versus conventional surgery: Scoping review

Knee osteoarthritis is a leading cause of disability. Although total knee arthroplasty (TKA) is cost-effective, up to 20% of patients remain dissatisfied. Computer-assisted surgery (CAS), including navigation and robotic-assisted techniques, aims to improve alignment accuracy and surgical reproducibility.

To compare radiological, clinical, and functional outcomes between conventional and computer-assisted primary TKA.

A scoping review was conducted according to PRISMA-ScR guidelines. A comprehensive search of PubMed/MEDLINE, EMBASE, and Cochrane databases (2011-2024) was performed using MeSH and DeCS terms derived from the PICO question. Randomized controlled trials, systematic reviews, and meta-analyses comparing conventional and CAS techniques were included. Twenty-three studies met inclusion criteria after independent paired screening.

Navigation and robotic-assisted TKA achieved significantly improved mechanical axis alignment and reduced proportion of alignment outliers (>±3°) compared with conventional TKA. Registry data suggest lower revision rates with navigation in patients younger than 65 years. Both CAS modalities demonstrated reduced systemic inflammatory response and less intraoperative soft tissue injury. However, no significant differences were found in long-term implant survivorship or functional outcomes at ≥10 years follow-up. Robotic-assisted TKA was associated with longer operative time and higher intraoperative costs, with conflicting evidence regarding overall cost-effectiveness.

CAS improves radiological accuracy and reproducibility in primary TKA but does not demonstrate superior long-term functional outcomes compared with conventional techniques. Clinical adoption should be individualized based on surgeon experience, institutional volume, patient comorbidities, and economic considerations.