Robot-assisted vs. navigation-assisted total knee arthroplasty: A systematic review and meta-analysis of the latest controlled studies based on perioperative, functional, and radiographic outcomes.

Total knee arthroplasty (TKA) is a cornerstone treatment for severe osteoarthritis (OA), yet debates persist regarding the comparative efficacy of robot-assisted (RA-TKA) versus navigation-assisted techniques (NA-TKA). This meta-analysis evaluates perioperative, functional, and radiographic outcomes of RA-TKA versus NA-TKA to guide clinical decision-making. A systematic review of 28 studies (2 RCTs, 26 retrospective cohorts) included 456,122 patients. Data were analyzed via RevMan 5.4 using random-effects models, focusing on hospital stay, surgical duration, complications, alignment accuracy, and functional scores. RA-TKA reduced hospital stay by 0.28 days (p < 0.001) and hospitalization costs by $1,289 (p < 0.001) but prolonged surgery by 8 min (p = 0.02). These findings should be interpreted with caution due to high heterogeneity. Complication rates were comparable, yet RA-TKA exhibited lower absolute incidences of prosthesis loosening (RA:110 vs. NA:378) and deep vein thrombosis (RA:272 vs. NA:1,480). Radiographic alignment showed no significant differences except smaller HKA angle deviations in RA-TKA (− 0.57°, p < 0.001). Functional outcomes (KOOS-JR, KSFS) marginally favored RA-TKA but lacked clinical significance. RA-TKA may offers economic and precision advantages in restoring mechanical alignment, despite longer surgery times. Large-scale RCTs are warranted to validate long-term benefits and cost-effectiveness.