Evidence

In brief

• “More accurate” may mean less deviation of a resection, axis, or component position from a plan. It is a technical endpoint, not a promise of less pain or longer implant survival.
• Clinical benefit must be assessed separately through patient-reported outcome measures (PROMs), complications, reoperations, revisions, and implant survivorship.
• Findings from one platform, version, or procedure cannot automatically be transferred to another.
• Short follow-up and weak comparator groups require more cautious conclusions.

The question comes first

Each evidence review defines the population, robotic intervention, comparator, outcome, and follow-up before interpreting results. This prevents a convenient technical metric from being substituted for the clinical question that matters.

An endpoint ladder

1. Plan execution: deviation of a resection or component from its planned value.
2. Radiographic geometry: limb alignment, component angles, and observations beyond a predefined threshold.
3. PROMs: validated measures of pain, function, and quality of life.
4. Safety: complications, reoperations, and adverse events, including system-related events.
5. Long-term outcome: revision and implant survivorship at a stated time point.

The first two levels describe technical reproducibility. They do not replace the latter three.

What evidence is available

Systematic reviews and meta-analyses provide an overall map; randomized studies offer comparisons with less confounding; prospective and retrospective cohorts add platform-specific or uncommon outcomes. Cadaveric and laboratory studies can test an instrument’s accuracy but cannot establish outcomes in patients.

How to read a result

Look for absolute values, confidence intervals, follow-up, and clinical importance—not only a p value. Statistical significance does not necessarily mean that patients notice a meaningful difference. Failure to detect a difference does not prove that two methods are fully equivalent.

Limitations of the evidence base

Studies combine different device generations, alignment strategies, implants, team experience, and outlier definitions. Surgeons cannot be blinded, learning curves may affect early series, and manufacturer funding or relationships need disclosure. Uncommon revision and complication outcomes require large cohorts and long follow-up.

Reviews by clinical question

• Accuracy in robotic-assisted TKA — resections, component position, alignment, and outliers.
• Clinical outcomes after robotic-assisted TKA — PROMs, complications, revisions, and survivorship.
• Component positioning in robotic-assisted THA — planned and achieved hip component position.

References

1. Robotic-assisted versus conventional TKA: systematic review and meta-analysis of RCTs.
2. Survivorship in robotic versus conventional TKA.
3. Robotic-assisted versus manual THA.

This material is for information and education only and is not a substitute for medical consultation. Diagnostic and treatment decisions must be made individually with a qualified healthcare professional.