Comparative Study of Post-operative Pain and Functional Outcomes in Robotic-assisted Total Knee Replacement versus Cruciate-retaining Manual Total Knee Replacement.

Introduction: Robotic-assisted total knee replacement (TKR) has emerged as an important technological advancement in arthroplasty surgery, designed to overcome the classical limitations of conventional jig-based instrumentation. Traditional manual techniques rely heavily on standard mechanical alignment systems and visual estimation, which introduce a higher margin for component malalignment and suboptimal soft-tissue balancing. By utilizing precise image-dependent or image-free navigation and haptic feedback loops, robotic arthroplasty provides real-time adjustments and micro-millimetric bone resections. The aim of this study was to compare post-operative pain patterns and functional recovery outcomes between robotic-assisted TKR and cruciate-retaining (CR) manual TKR in patients diagnosed with end-stage knee osteoarthritis. Material and Methods: The study protocol was approved by the Institutional Ethics Committee, and written informed consent was obtained from all patients before inclusion in the study. Fifty patients undergoing unilateral primary TKR for end-stage osteoarthritis were prospectively enrolled and followed. The cohort was distributed evenly into two groups: 25 patients underwent robotic-assisted TKR, and 25 patients underwent traditional manual CR TKR. Post-operative pain trajectories were assessed using the Visual Analog Scale (VAS) preoperatively and on post-operative days (POD) 1, 3, and 5. Immediate physical recovery was quantified using the time taken to achieve first independent ambulation in hours. Short-term functional recovery was documented using the Knee Society Score (KSS) system at 6 weeks and 3 months postoperatively. Result: Pre-operative demographics, including age, gender distribution, and baseline body mass index, were statistically comparable across both groups (P > 0.05). The robotic-assisted cohort demonstrated significantly lower VAS scores than the manual group on POD1 (4.1 vs. 6.2; P < 0.001), POD3 (3.0 vs. 4.8; P < 0.001), and POD5 (2.2 vs. 3.1; P = 0.002). Patients in the robotic-assisted cohort achieved first ambulation significantly faster (18.3 h vs. 29.1 h; P < 0.001). Functional recovery tracked through KSS confirmed superior outcomes in the robotic-assisted group at 6 weeks (82.4 vs. 74.8; P = 0.003) and at 3 months (90.1 vs. 83.7; P = 0.001). Conclusion: Robotic-assisted TKR provides superior early post-operative recovery compared with conventional CR manual TKR, minimizing early post-operative pain, accelerating mobilization milestones, and enhancing short-term functional outcomes, thereby supporting contemporary enhanced recovery after surgery pathways in orthopedic joint reconstruction.