Robotic-Assisted Total Knee Arthroplasty: Current Evidence on PROMs, Functional Outcomes, Neuromotor Recovery, and Complications—A Narrative Review

Background and Objectives: Robotic-assisted total knee arthroplasty (rTKA) is being increasingly used to improve surgical precision, soft-tissue balancing, and functional recovery. However, evidence comparing rTKA with conventional manual TKA (mTKA) across functional, patient-reported, neuromotor, and safety outcomes remains heterogeneous. Materials and Methods: This narrative (non-systematic) review synthesises studies evaluating functional outcomes, patient-reported outcome measures (PROMs), joint awareness, range of motion (ROM), neuromotor recovery, and complications following rTKA versus mTKA. Study inclusion was based on author judgement and data accessibility. The reviewed evidence included five randomised controlled trials, 9 retrospective studies, six prospective non-randomised studies, two meta-analyses, one cross-sectional study, and one umbrella review, covering CT-based and imageless robotic platforms, including semi-active and active systems such as MAKO, NAVIO, CORI, ROSA, ROBODOC, CUVIS Joint, SkyWalker, TSolution One, AKEC, JIANJIA, and YUANHUA. Results: rTKA consistently demonstrated outcomes comparable to mTKA in PROMs (OKS, KOOS, WOMAC, KSS), with some studies reporting modest early improvements in pain and function. Joint awareness and patient satisfaction showed the most consistent early advantages for rTKA. Early postoperative ROM and neuromotor recovery, including balance and gait symmetry, were improved with rTKA, likely due to enhanced alignment and soft-tissue balancing; however, mid- and long-term outcomes were similar. Complication rates were low and comparable, with robotic-specific issues being rare and self-limited. Conclusions: rTKA provides small but reproducible early benefits in joint awareness, neuromotor function, and patient satisfaction, without clear long-term superiority. These early advantages may translate into meaningful population-level benefits, including faster recovery and potential healthcare cost reduction. Further high-quality studies are needed to assess long-term clinical and economic outcomes.