Comparison of MAKO robotic-assisted and manual unicompartmental knee arthroplasty: a meta-analysis of radiographic precision and short-term functional results

Background: This study sought to evaluate whether the MAKO robotic system offers superior radiographic and functional advantages over traditional techniques in unicompartmental knee replacement (UKA). Methods: A systematic literature search was performed through October 2025 across multiple electronic platforms, such as PubMed, Web of Science, Cochrane Library, Embase, Scopus, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), Wanfang, China Biology Medicine Disc (CBM), and China Science and Technology Journal (CSTD). A total of 8,924 UKAs from 22 studies were included. Results: Findings indicated that MAKO-UKA and conventional methods yielded comparable scores for Visual Analogue Scale(VAS, P = 0.46 ), Pain Catastrophizing Scale(PCS, P = 0.3), American Knee Society Score (AKSS, P = 0.63), AKSS Total (P = 0.7), AKSS function(AKSSF, P = 0.66), Oxford Knee Score (OKS, P = 0.59); Forgotten Joint Score (FJS, P = 0.44), Mechanical femorotibial axis (MFTA, P = 0.07), Tibial component Coronal alignment (TCCA, P = 0.45), Tibial component posterior tilt(TCPT, P = 0.64), Lateral femoral component flexion-extension angle (LFCFEA, P = 0.96), Range of motion(ROM, P = 0.29 ), Complication rate(P = 0.53), Periprosthetic joint infection rate(PJI, P = 0.07), Revision rate(P = 0.14). However, MAKO-UKA was associated with improved femoral component coronal alignment (FCCA, P = 0.04), fewer FCCA outliers (P < 0.001), fewer TCCA outliers (P = 0.03), and reduced tibial posterior slope (PTS, P = 0.017), albeit with longer operative time (P < 0.001). Conclusion: While MAKO-UKA offers enhanced surgical precision and fewer alignment outliers, these technical advantages do not yet translate into superior short-term functional outcomes. Given the significant increase in procedural duration and the near-significant trend in infection rates, clinicians should remain vigilant. We emphasize that rigorous training and a focus on minimizing operative time are crucial for the safe implementation of this technology.