Robotic-assisted total knee arthroplasty: accuracy, clinical outcomes, complications, learning curve and cost-effectiveness: a critical clinical review.

Robotic-assisted total knee arthroplasty (RA-TKA) has been adopted to improve surgical planning, bone preparation, component positioning, and limb alignment. This critical clinical review evaluates whether these technical gains improve outcomes that matter to patients and healthcare systems. The PubMed/MEDLINE, Web of Science, and Scopus databases were searched on July 6, 2026, using prespecified RA-TKA search terms and targeted searches for specific endpoints. A supplementary PubMed search on August 10, 2026, focused on soft-tissue balancing, ligament balancing, gap assessment, medial release, and alignment strategy. Evidence was prioritized from systematic reviews, meta-analyses, randomized trials, registry and database studies, health economic evaluations, and learning-curve studies. The most consistent finding is improved radiographic or technical accuracy, including fewer alignment outliers and closer execution of planned implant position. Evidence for patient-reported outcomes, pain, satisfaction, range of motion, and early recovery is more heterogeneous, and reported advantages are often modest or short-term. Safety appears acceptable in trained teams, although pin-related, registration, workflow, and conversion risks require explicit attention. Long-term survivorship superiority and broad cost-effectiveness remain insufficiently proven. RA-TKA improves precision more reliably than it improves durable patient-level outcomes. Its clinical value depends on patient selection, platform, alignment and balancing strategy, surgeon and team experience, volume, and cost structure.