CEMENTLESS VERSUS CEMENTED FIXATION IN ROBOTIC-ASSISTED TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Cementless fixation in total knee arthroplasty (TKA) has gained interest due to its potential for biological osseointegration, avoidance of cement-related complications, and improved long-term implant fixation, particularly in younger patients. However, it is technically demanding, requiring precise implant positioning, an area where robotic assistance may offer advantages. Despite increasing adoption of robotic-assisted TKA, outcomes specific to cementless robotic fixation have not been systematically synthesised. A systematic search of CENTRAL, Embase, PubMed, and Scopus was performed. Comparative studies evaluating adult patients undergoing primary cementless robotic-assisted TKA versus cemented robotic-assisted or manual TKA were included. Meta-analyses were conducted using random-effects models in R. Twelve studies were included, comprising 161,315 patients across pooled analyses. Versus cemented robotic TKA, cementless robotic TKA showed: all-cause revision OR 0.75, non-significant (CI [0.36, 1.54]; I 2 = 45); Oxford Knee Score MD 0.52 points, non-significant (CI [−0.75, 1.79]; I 2 = 28%); manipulation under anaesthesia OR 0.97, non-significant (CI [0.43, 2.19]; I 2 = 55%); operative time MD −15.94 minutes, significant (CI [−27.53, −4.35]; I 2 = 92%); length of stay MD −0.39 days, significant (CI [−0.52, −0.26]; I 2 = 0%). Versus manual cementless TKA, cementless robotic TKA showed: revision OR 0.86, non-significant (CI [0.64, 1.15]; I 2 = 35%); infection OR 1.28, non-significant (CI [0.90, 1.81]; I 2 = 5%). At short- to mid-term follow-up, cementless robotic-assisted TKA does not confer improved clinical outcomes or reduced complication rates compared with cemented robotic or manual cementless techniques. Benefits appear limited to operative efficiency and reduced length of stay.