Robotic-assisted TKA using functional alignment principles yields favorable outcomes and low early revision riskRobotic assistance improves outcomes for patients with knee osteoarthritis

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Published September 3, 2026 Study authors: Giovanoulis Vasileios, Vasiliadis Angelo V, Andriollo Luca, Gregori Pietro, Dretakis Konstantinos, K… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that robotic-assisted TKA with functional alignment yields improved functional scores and low early revision risk.

This systematic review and meta-analysis evaluates the clinical outcomes of robotic-assisted total knee arthroplasty (TKA) performed under functional alignment (FA) principles in 5155 adult patients. The study focuses on functional outcomes and early revision risk over a weighted mean follow-up of 2.5 years.

Key findings indicate significant improvements in patient-reported outcomes, including KSS Knee scores of 92.4-94.5 and KSS Function scores of 91.4-93.4. Additionally, Forgotten Function Scores (FJS) ranged from 74.8-77.5, and Kujala scores for anterior knee pain were 88.1-93.2. Range of motion (ROM) improved from 119.3 degrees to 123-124.8 degrees. The meta-analysis reported a low early revision risk of 0.00 (95% CI 0.00-0.01; I2 = 0%) and a total of 18 aseptic revisions (0.35%, 95% CI 0.23-0.55).

Limitations noted by the authors include heterogeneous evidence and uncertain long-term safety. Clinical application is supported by favorable short- to mid-term functional outcomes and low early revision rates, though long-term durability remains less certain.

How this fits prior evidence

This finding addresses a gap in surgical techniques for knee osteoarthritis by evaluating robotic-assisted TKA under functional alignment principles. While previous evidence identified infection (27.5%) and instability (13.6%) as primary drivers of failure in revision TKA, this study provides data on early revision risk (0.00) and functional outcomes in primary robotic-assisted cases. It complements existing evidence on non-pharmacological and technological interventions for knee osteoarthritis.

Living with knee osteoarthritis can make simple movements painful and difficult. For those facing surgery, the goal is a replacement that restores function and lasts a long time. A review of data from over 5,000 patients shows that using a robot to guide the surgery under specific alignment principles can lead to better results.

Patients who underwent this robotic-assisted procedure reported better scores for knee function and range of motion. Specifically, the average range of motion improved from 119.3 degrees to over 123 degrees. These results were measured about 2.5 years after surgery. The data also showed a very low risk of needing a revision, which is a follow-up surgery to fix a problem.

While the results are promising for short-term and mid-term recovery, there are some things to keep in mind. The evidence comes from different types of studies, and we do not yet know the long-term safety of this method over many years. Some patients did experience stiffness that required medical intervention, but the overall early revision rates remained low.

What this means for you:

Robotic-assisted knee surgery shows improved movement and low early revision rates for osteoarthritis patients.

Common questions

How does robotic-assisted surgery help my knee?

Robotic-assisted surgery uses an image-based system to help surgeons place the implant. For patients with knee osteoarthritis, this method resulted in improved scores for knee function and a better range of motion, which increased from 119.3 degrees to between 123 and 124.8 degrees.

Is there a risk of needing a second surgery?

The study found a very low risk of early revision, which is a follow-up surgery. The data showed a 0.35% rate for aseptic revisions, meaning the risk of needing a new surgery shortly after the initial procedure is quite low based on the 2.5-year follow-up.

Are there any known side effects or complications?

Some patients experienced stiffness that required manipulation under anesthesia. However, the study did not report any serious adverse events. Because the evidence is from varied sources, you should talk to your doctor about how these results apply to your specific case.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up24.0 mo

PublishedSep 2026

PMID41358691

View Original Abstract ↓

PURPOSE: Functional alignment (FA) has emerged as a personalised alignment strategy in total knee arthroplasty (TKA), enabled by robotic-assisted technology. Although early clinical results are encouraging, evidence remains heterogeneous and long-term safety is uncertain. This systematic review aimed to evaluate functional outcomes, and early revision risk of robotic-assisted TKA performed under FA principles with a minimum follow-up of 2 years. METHODS: This review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251134340). PubMed/MEDLINE and Scopus were searched up to August 2025. Eligible studies included adult patients undergoing robotic-assisted primary TKA with FA, reporting outcomes at ≥2 years' follow-up. Data on demographics, robotic system, implant type, patient-reported outcome measures (PROMs), range of motion (ROM), complications, and revision rates were extracted. Risk of bias was assessed using ROB 2 and ROBINS-I. A random-effects single-arm meta-analysis of pooled proportions was performed for early aseptic revision risk. RESULTS: Twenty studies (5155 TKAs) were included, with a weighted mean follow-up of 2.5 years. All procedures were performed using the image-based robotic system. Postoperative PROMs were consistently high: Knee Society Score (KSS) Knee 92.4-94.5, KSS Function 91.4-93.4, and FJS 74.8-77.5. Kujala scores indicated minimal anterior knee pain (88.1-93.2). ROM improved from a mean preoperative flexion of 119.3° to 123°-124.8°. Complications were infrequent, most commonly stiffness requiring manipulation under anaesthesia. Across all cohorts, 18 aseptic revisions were reported (pooled proportion 0.35%, 95% CI 0.23-0.55). The single-arm meta-analysis of pooled proportions showed a negligible pooled early revision risk (rounded to 0.00; 95% CI 0.00-0.01; I² = 0%). Outcomes were comparable across age, gender, fixation type, and implant constraint, although obese patients accounted for all mechanical failures. CONCLUSION: Robotic-assisted TKA performed under FA principles yields favourable short- to mid-term functional outcomes and a low rate of early aseptic revision. LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

Robotic-assisted TKA using functional alignment principles yields favorable outcomes and low early revision riskRobotic assistance improves outcomes for patients with knee osteoarthritis

How this fits prior evidence

Common questions

Study Details

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Robotic-assisted TKA using functional alignment principles yields favorable outcomes and low early revision riskRobotic assistance improves outcomes for patients with knee osteoarthritis

How this fits prior evidence

Common questions

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