Robotic-assisted total knee arthroplasty demonstrates superior early functional outcomes compared with conventional total knee arthroplasty: a quasi-randomised controlled trial
4 affiliations
- 1Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
- 2Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40(Saale), 06097 Halle, Germany
- 3Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
- 4Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del, 00165 Rome, Italy
Abstract
Background: Robotic-assisted total knee arthroplasty (TKA) has gained popularity over the last decade, with claimed advantages in implant positioning accuracy and soft-tissue balance. Whether these technical advantages translate into better clinical outcomes for patients remains debated. This investigation compared 1-year patient-reported outcomes between robotic-assisted and conventional TKA performed within the same institution but following structurally different surgical workflows.
Methods: This quasi-randomised controlled trial enrolled patients who underwent primary TKA at the Department of Orthopaedic and Trauam Surgery of the Eifelklink St. Brigida (Simmerath, Germany) between 2022 and 2025. Group allocation was determined by surgeon assignment through the institutional digital scheduling system. All patients received the same implant (Smith & Nephew Legion Genesis II, posterior-stabilised). Robotic-assisted procedures were performed using the CORI Robotic System (Smith & Nephew, UK) following a four-dimensional personalised alignment workflow (coronal, sagittal, transversal and balancing) guided intraoperatively by the Knee Balancing Score (KBS). Conventional procedures followed a femur-first technique with adjusted mechanical alignment. Outcomes included WOMAC total and subscores, visual analogue scale (VAS), Tegner activity score and a dedicated functional questionnaire, all assessed at 1-year follow-up.
Results: A total of 845 patients were included (robotic-assisted: n = 390; conventional: n = 455). At 1-year, 383 and 445 patients completed follow-up, respectively. The two groups were comparable at baseline. The robotic-assisted cohort showed significantly better results across WOMAC and related subscales (P < 0.001), VAS (P < 0.001), Tegner (P < 0.001), functional and satisfaction items, including walking distance and knee stability. No difference was found in the use of walking aids.
Conclusions: Robotic-assisted TKA was associated with superior functional and patient-reported outcomes at the 1-year follow-up. The clinical benefit observed is likely not attributable to robotic precision alone, but reflects the structured, personalised intraoperative workflow that robotic assistance enables.
Trial Registry German Registry of Clinical Trials (ID DRKS00030614).
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BibTeX
@article{migliorini2026roboticassisted,
title = {{Robotic-assisted total knee arthroplasty demonstrates superior early functional outcomes compared with conventional total knee arthroplasty: a quasi-randomised controlled trial}},
author = {Filippo Migliorini and Luise Schäfer and Andrea Nobili and Daniel Kämmer and Jens Schneider and Andreas Bell},
journal = {Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology},
year = {2026},
month = nov,
doi = {10.1186/s10195-026-00979-7},
url = {https://doi.org/10.1186/s10195-026-00979-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Robotic-assisted total knee arthroplasty demonstrates superior early functional outcomes compared with conventional total knee arthroplasty: a quasi-randomised controlled trial
AU - Filippo Migliorini
AU - Luise Schäfer
AU - Andrea Nobili
AU - Daniel Kämmer
AU - Jens Schneider
AU - Andreas Bell
PY - 2026
DA - 2026/11/03
JO - Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
DO - 10.1186/s10195-026-00979-7
UR - https://doi.org/10.1186/s10195-026-00979-7
AB - Background: Robotic-assisted total knee arthroplasty (TKA) has gained popularity over the last decade, with claimed advantages in implant positioning accuracy and soft-tissue balance. Whether these technical advantages translate into better clinical outcomes for patients remains debated. This investigation compared 1-year patient-reported outcomes between robotic-assisted and conventional TKA performed within the same institution but following structurally different surgical workflows. Methods: This quasi-randomised controlled trial enrolled patients who underwent primary TKA at the Department of Orthopaedic and Trauam Surgery of the Eifelklink St. Brigida (Simmerath, Germany) between 2022 and 2025. Group allocation was determined by surgeon assignment through the institutional digital scheduling system. All patients received the same implant (Smith & Nephew Legion Genesis II, posterior-stabilised). Robotic-assisted procedures were performed using the CORI Robotic System (Smith & Nephew, UK) following a four-dimensional personalised alignment workflow (coronal, sagittal, transversal and balancing) guided intraoperatively by the Knee Balancing Score (KBS). Conventional procedures followed a femur-first technique with adjusted mechanical alignment. Outcomes included WOMAC total and subscores, visual analogue scale (VAS), Tegner activity score and a dedicated functional questionnaire, all assessed at 1-year follow-up. Results: A total of 845 patients were included (robotic-assisted: n = 390; conventional: n = 455). At 1-year, 383 and 445 patients completed follow-up, respectively. The two groups were comparable at baseline. The robotic-assisted cohort showed significantly better results across WOMAC and related subscales (P < 0.001), VAS (P < 0.001), Tegner (P < 0.001), functional and satisfaction items, including walking distance and knee stability. No difference was found in the use of walking aids. Conclusions: Robotic-assisted TKA was associated with superior functional and patient-reported outcomes at the 1-year follow-up. The clinical benefit observed is likely not attributable to robotic precision alone, but reflects the structured, personalised intraoperative workflow that robotic assistance enables. Trial Registry German Registry of Clinical Trials (ID DRKS00030614).
SN - 1590-9921
SN - 1590-9999
ER -