Comparative Clinical Outcomes of Robotic-Assisted and Conventional Total Knee Arthroplasty: A Retrospective Cohort Study.

Background Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an innovative technology aimed at improving surgical precision and optimizing postoperative outcomes. However, whether these technical advantages translate into meaningful clinical benefits compared with conventional total knee arthroplasty (C-TKA) remains uncertain. Objective To compare early postoperative functional recovery (primary outcome) and perioperative outcomes, complications, revision surgery, and patient satisfaction (secondary outcomes) over 12 months in patients undergoing primary unilateral total knee arthroplasty (TKA) using robotic-assisted or conventional techniques. Methods This retrospective cohort study included 301 patients who underwent primary TKA at a specialized orthopedic center over a two-year period. Of these, 87 patients underwent RA-TKA and 214 underwent C-TKA. Baseline demographic and clinical characteristics were comparable between groups. Perioperative outcomes, patient-reported outcome measures, complications, and satisfaction rates were evaluated. Multivariable linear regression and propensity score matching (1:2 nearest-neighbor matching) were performed to identify independent predictors of recovery and reduce selection bias. Results Robotic-assisted TKA was associated with significantly longer operative time (108.4 ± 14.2 vs. 88.6 ± 11.5 minutes; p<0.001) but demonstrated lower blood loss (255 ± 92 vs. 289 ± 105 mL; p=0.03), reduced postoperative hemoglobin decline (1.9 ± 0.7 vs. 2.2 ± 0.8 g/dL; p=0.01), and shorter hospital stay (4.2 ± 1.1 vs. 4.8 ± 1.3 days; p=0.01). Statistically significant improvements in early functional outcomes were observed in the robotic cohort at 6 weeks and 3 months; however, none of these differences exceeded established minimal clinically important difference (MCID) thresholds. At 12 months, functional outcomes were comparable between groups. Complication rates, revision surgery, and patient satisfaction did not differ significantly. Robotic-assisted TKA remained an independent predictor of improved three-month Knee Society Score following multivariable adjustment and propensity score matching. Conclusions RA-TKA provides superior early postoperative recovery, reduced perioperative morbidity, and shorter hospitalization compared with conventional TKA. No statistically significant differences were observed in complications or one-year clinical outcomes, although the study was underpowered to detect small differences in rare adverse events.