A Comparison of Operative Time Between Robotic Surgical Assistant (ROSA) and MAKO Robotic-Assisted Total Knee Arthroplasty: A Meta-Analysis.

Robotic-assisted total knee arthroplasty (TKA) represents a modern surgical approach that seeks to enhance implant precision and alignment compared to traditional methods. The Robotic Surgical Assistant (ROSA) and MAKO platforms represent two prominent systems used in robotic surgery. A systematic search of PubMed and Embase was performed through December 2024 to identify comparative studies of ROSA and MAKO robotic systems in TKA. Eligible studies reported operative time outcomes. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for each study. Pooled analyses were conducted using both fixed-effect and random-effects models. Heterogeneity was assessed using the Q statistic and I². Three studies met the inclusion criteria, with a combined sample of 1,222 patients. The fixed-effects model showed a small but statistically insignificant pooled effect favoring ROSA (Hedges' g = 0.21, standard error = 0.07, 95% CI = -0.07 to 0.50), corresponding to approximately 6-7 minutes shorter operative time. The random-effects model demonstrated a similar trend, though non-significant due to high heterogeneity (Q = 20.07, p < 0.001, I² = 90%). Funnel plot analysis revealed no evidence of publication bias. The meta-analysis indicates that ROSA might result in shorter surgical times than MAKO during TKA procedures, although statistically insignificant. The results are restricted by substantial heterogeneity between studies and the limited number of available studies.