Abstract

Aim: To systematically evaluate the clinical effectiveness of Mako total knee arthroplasty compared with conventional jig-based TKA, focusing on functional outcomes, implant positioning, complications, length of stay (LOS), postoperative pain, and recovery time.
Method: A systematic review and meta-analysis was conducted following PRISMA guidelines. Prospective, retrospective, and registry-based comparative studies were included. Data were extracted for validated functional scores (OKS, KOOS-JR, VR-12), alignment parameters (hip–knee–ankle angle, outlier rates), perioperative complications, LOS, and VAS pain at multiple timepoints. Random-effects models were used for quantitative synthesis; heterogeneous outcomes (time to recovery milestones, gait analysis) were synthesised narratively. Certainty of evidence was assessed using GRADE.
Results: Twenty-one studies (n = 51,226) were included. At 12 months, robotic patients demonstrated modest improvements in functional outcomes (OKS pooled MD +2.5, 95% CI +1.0 to+3.9), approaching the minimal clinically important difference. Robotic TKA reduced alignment outliers. There was no consistent difference in periprosthetic joint infection or early revision rates. LOS was ∼0.5 days shorter with robotic, an effect confined to non-ERAS pathways. Pain outcomes showed no acute benefit, but a 6-month meta-analysis (Yang 2024, Masilamani 2025; n = 286) demonstrated lower pain with robotic (MD −0.43, 95% CI −0.57 to −0.28). Narrative synthesis indicated faster inpatient recovery milestones in conventional care but no advantage under ERAS protocols.
Conclusions: Robotic TKA confers small but consistent benefits in functional outcomes, alignment precision, LOS, and mid-term pain, without clear reductions in major complications. These advantages are context-dependent, most evident outside ERAS pathways. Higher-quality RCTs are required to confirm long-term clinical relevance.