Does Robotic‐Assisted Total Knee Arthroplasty Improve Outcomes of Adult Osteoarthritis Patients—A Systematic Review and Trial Sequential Meta‐Analysis

摘要

ABSTRACT Background and Objectives Total knee arthroplasty (TKA) is a standard treatment for end‐stage knee osteoarthritis (KOA). While conventional TKA (cTKA) is widely used, robotic‐assisted TKA (rTKA) has gained attention for its potential precision and improved outcomes. However, the comparative efficacy and safety of rTKA versus cTKA remain unclear due to inconsistent findings in existing studies. This study aims to systematically review and compare the efficacy and safety of rTKA and cTKA in patients with KOA. Methods A total of seven databases were searched. Only randomized controlled trials (RCTs) were included in this systematic review. Subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA) were used to evaluate the stability of the results. Results Twenty‐five RCTs involving 3156 patients with KOA were included. The only statistically significant clinical difference between patients who received rTKA and cTKA was that the rTKA group was associated with a longer operative duration (MD = 22.38 mins; 95% confidence interval [CI] [12.86, 31.91]; p < 0.00001; I 2 = 98%). As for functional parameters, the two groups had similar results in postoperative Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC), and Hospital for Special Surgery Score (HSS). Regarding the tibiofemoral angle and the coronal femoral component angle, no significant difference was observed between the two groups. Patients in the rTKA group had a higher hip–knee–ankle angle (HKA) (MD = 0.63; 95% CI [0.23, 1.03]; p = 0.002; I 2 = 52%), lower HKA deviation (MD = −0.99; 95% CI [−1.24, −0.74]; p < 0.00001; I 2 = 0%), and a higher coronal tibial component angle (MD = 0.46; 95% CI [0.07, 0.85]; p = 0.02; I 2 = 81%) after the surgery. Conclusions While rTKA appears to be a feasible and safe alternative to cTKA, the mixed evidence from our study highlights the need for further research to fully understand its clinical implications and long‐term outcomes. Trial Registration: PROEPERO: CRD42024541052