Return to sports after robotic-assisted versus conventional total and unicompartmental knee arthroplasty: a systematic review of the current evidence

Return to sports (RTS) has become an increasingly common expectation for patients undergoing total or unicompartmental knee arthroplasty (TKA and UKA), particularly among younger and more active individuals. Although current evidence has not demonstrated superior clinical outcomes with robotic-assisted (RA) surgery, its ability to improve the accuracy of component positioning, soft-tissue balancing and limb alignment might translate into improved RTS outcomes. To systematically review the literature assessing RTS outcomes after robotic-assisted versus conventional TKA and/or UKA. A comprehensive search of PubMed, Embase, and Web of Science was performed on October 20, 2025 and updated on March 25, 2026. Eligible studies included clinical investigations reporting RTS and/or physical activity–related outcomes in patients undergoing TKA or UKA, with a direct comparison between RA and conventional surgery. Methodological quality was assessed using the modified Coleman Methodology Score (mCMS). This review was registered in PROSPERO (CRD420251245057). The searches identified a total of 1,260 records. After removing duplicates and screening, 7 studies met the inclusion criteria. Overall, RA knee arthroplasty yielded RTS outcomes comparable to those of conventional techniques. Most studies reported no significant differences in UCLA Activity Scale, Tegner Activity Scale, KOOS Sport and Recreation, or KSS functional advanced activity scores at short‑ to mid‑term follow-up. One study found greater improvement in KOOS Sport and Recreation after RA-TKA, and another reported a faster RTS following robotic-assisted lateral UKA. Current evidence from the available literature does not demonstrate the superiority of RA-TKA or RA-UKA over conventional techniques with respect to RTS outcomes. However, the limited number of available studies and the substantial heterogeneity in study design and outcome measures precludes definitive conclusions. Further high-quality studies using standardized, sport-specific outcome measures are needed to clarify the potential benefits of RA in this setting.