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Robotic-Assisted Total Knee Arthroplasty: Innovations, Outcomes, and Challenges—A Comprehensive Review

  • Umile Giuseppe Longo 1, 2, *,   
  • Matteo Di Benedetto 2,   
  • Matteo Lavorato 2,   
  • Alessandro de Sire 3, 4,   
  • Pieter D’Hooghe 5

Received: 06 May 2025 | Revised: 31 Jul 2025 | Accepted: 31 Jul 2025 | Published: 02 Sep 2025

Abstract

Background: Total knee arthroplasty (TKA) reliably relieves pain in end-stage knee osteoarthritis, yet up to 20% of patients report persistent dissatisfaction due to factors like component malalignment or soft-tissue imbalance. Robotic-assisted TKA has emerged to enhance surgical precision and enable patient-specific alignment strategies beyond the traditionally targeted neutral mechanical alignment. Purpose: To synthesize current knowledge on the role of robotic systems in TKA, including technological classifications, clinical outcomes, safety profile, economic considerations, and adoption challenges. Methods: We conducted a narrative review of literature on robotic-assisted total knee arthroplasty (RA-TKA) published from 2010 to 2025. Articles were primarily identified via PubMed searches, supplemented by reference review and expert recommendation. Of the 36 included studies, 8 were systematic reviews or meta-analyses, 2 randomized controlled trials, 6 registry or database studies, 14 cohort studies or case series, 3 narrative reviews or expert opinion papers, and 1 technical or biomechanical study. Results: Semi-active robotic TKA systems consistently improve bone-cutting accuracy and alignment precision, dramatically reducing alignment outliers beyond 3° of neutral compared to conventional techniques. Robotic TKA has been associated with reduced early postoperative pain, faster recovery, and shorter hospital stays. Mid-term outcomes appear equivalent or slightly improved relative to conventional TKA, with similar safety profiles. Conclusion: Robotic-assisted TKA enhances surgical precision and early recovery without increasing complication risk. Long-term benefits, overall cost-effectiveness, and broad applicability of this technology remain under investigation.

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Longo, U. G.; Benedetto, M. D.; Lavorato, M.; Sire, A. d.; D’Hooghe, P. Robotic-Assisted Total Knee Arthroplasty: Innovations, Outcomes, and Challenges—A Comprehensive Review. Journal of Orthopaedics, Rehabilitation and Sports Medicine 2025, 1 (1), 2.
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