Robot-assisted versus manual total and unicompartmental knee arthroplasty: a systematic review and network meta-analysis
Robot-assisted knee arthroplasty has been adopted rapidly on the premise that improved component positioning and alignment translate into better clinical outcomes for patients. The supporting evidence, however, consists largely of pairwise comparisons of a single robotic technique against its manual counterpart, and the four surgical strategies available for knee osteoarthritis have never been compared within one analysis. This leaves surgeons without a direct basis for choosing between them, particularly where a partial and a total replacement are both reasonable options. This study compares four treatment strategies — total knee arthroplasty, robot-assisted total knee arthroplasty, unicompartmental knee arthroplasty, and robot-assisted unicompartmental knee arthroplasty — within a single network meta-analysis. This approach allows all four treatments to be compared simultaneously, using both the direct comparisons made within studies and the indirect comparisons between them. Several outcomes were assessed. Revision rates and complications were used to evaluate safety, and operative time was used to evaluate the burden of the procedure itself. Functional and patient-reported scores and range of motion were used to evaluate recovery. We anticipate that the four strategies will show broadly comparable clinical and functional outcomes, and that the robot-assisted procedures will require longer operative time than their manual counterparts. By placing all four options in one network, the study is intended to clarify whether robotic assistance delivers a measurable clinical benefit or whether its advantages are confined to the technical aspects of the operation.