Robotic-assisted total knee arthroplasty: radiological precision, clinical outcomes, and benchmarks for emerging systems.

Robotic-assisted total knee arthroplasty (RA-TKA) has spread on the promise of greater precision, yet whether that precision improves what patients experience is unsettled. This review synthesizes evidence on the radiological precision and clinical outcomes of RA-TKA, situates its health-economic case, and defines benchmarks for emerging platforms. Structured non-systematic review of peer-reviewed literature indexed in PubMed/MEDLINE (January 2015-December 2025), with predefined eligibility criteria and a level of evidence assigned to every cited clinical study by Oxford Centre for Evidence-Based Medicine 2011 criteria. Manufacturer and institutional sources were used only where peer-reviewed data are absent, and are identified as such. RA-TKA more than halves the risk of a hip-knee-ankle deviation beyond three degrees, with the largest gains in severe deformity; between robotic platforms these differences largely disappear. Component positioning improves against manual instrumentation, though gap-balancing evidence is thin and largely single-platform. Early recovery favors robotics, but one-year scores, satisfaction, and implant survival mostly match conventional TKA (C-TKA). One retrospective series reported more manipulation under anesthesia after robotic surgery; the finding is not reproduced elsewhere and tracks a default tibial slope target. The economic case holds under bundled payment but not under French activity-based tariffs. RA-TKA delivers measurable radiological precision whose translation into durable patient benefit remains unproven at a predominantly Level III standard of evidence. Most comparative data derive from a single image-based platform and rarely extend beyond two years. Emerging platforms should be judged against defined evidentiary standards, including safety, rather than engineering credentials. Level of Evidence. V (narrative review).