SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Functional alignment in robotic total knee arthroplasty provides favourable outcomes and minimal early revisions: A systematic review and meta-analysis.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Efficacy of MAKO robot-assisted total knee arthroplasty compared with conventional total knee arthroplasty in patients with knee joint diseases: a systematic review and meta-analysis.Frontiers in bioengineering and biotechnology · 2026Pooled it
- Functional alignment: Defined personalized alignment strategy with promising outcomes and room for improvement.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Cost-utility analysis of robotic and conventional total knee arthroplasty: A 200-patient micro-costing study in a public sector institution.Journal of robotic surgery · 2026Article
- Does implant weight matter? The effect of total knee arthroplasty on thigh mass distribution and estimated hip loading.Journal of experimental orthopaedics · 2026Article
- Evaluation of the Coronal Plane Alignment of the Knee (CPAK) classification in arthritic knees following robotic total knee arthroplasty.BMC musculoskeletal disorders · 2026Article
- Functional versus mechanical alignment in robotic primary total knee arthroplasty: A meta-analysis.SICOT-J · 2026Article
- Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeFunctional 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.
methodsThis 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.
resultsTwenty 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.
conclusionRobotic-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.
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