Robotic arthroplasty and the gap between technical precision and clinical benefit

Robotic-assisted arthroplasty improves resection accuracy, component positioning, and reproducibility. Whether these technical gains produce clinically meaningful benefits remains uncertain. This expert narrative review drew on PubMed, Embase, and Web of Science searches performed on April 28, 2026. Systematic reviews and randomized trials were prioritized, supplemented by observational, registry, economic, and technical studies. Evidence was appraised qualitatively by design, follow-up, bias, and platform differences; technical endpoints were assessed separately from patient-important outcomes. Evidence most consistently supports fewer alignment and component-positioning outliers. Functional and perioperative benefits vary by procedure, platform, outcome, and follow-up; evidence for generalizable long-term benefit remains inconsistent. The precision-target gap is proposed as one explanation: more accurate execution may yield limited benefit when the surgical target is insufficiently validated for the patient. Small differences from conventional care, confounding, and outcome measurement provide alternative explanations. Clinical value requires evidence that a surgical target improves outcomes and that robotic delivery adds benefit. Patient-specific models, intraoperative sensing, and decision support require external validation and prospective comparison with optimized conventional care. Adoption should reflect patient-important outcomes, cost-effectiveness, and local practice.