Robotic-assisted patellofemoral arthroplasty shows superior functional outcomes and lower revision rates compared to conventional technique: a systematic review and meta-analysis

Introduction: : Patello-femoral osteoarthritis is a degenerative condition causing anterior knee pain, stiffness, and functional impairment due to cartilage degeneration in the patello-femoral compartment. This systematic review summarises the clinical and functional outcomes of robotic-assisted patello-femoral arthroplasty (RA-PFJA), focusing on pain relief and complication rates, and includes a meta-analysis of reoperation and revision rates from comparative studies between RA-PFJA and conventional PFJA. Materials and methods: A meta-analysis was performed for revision and reoperation rates, while other outcomes were summarised descriptively. This research was conducted across multiple databases according to the Cochrane Handbook and PRISMA guidelines. Eight studies met the inclusion criteria. Outcomes assessed included Oxford Knee Score (OKS), Kujala score, Knee Society Score (KSS), visual analogue scale (VAS), length of hospital stay (LOS), complication, revision, and reoperation rates. Results: Eight studies with a total of 992 patients treated with RA-PFJA were included (641 with Mako, 166 with Navio, 175 with unspecified systems). The mean follow-up was 47.5 ± 29.4 months. RA-PFJA showed excellent final function (Kujala: 87.4 ± 14.1; OKS: 39.6 ± 5.4; KSS: 81.0 ± 14.2) and significant pain reduction (p < 0.001). Compared to conventional PFJA, RA-PFJA had a lower overall complication rate (15% vs. 30%), lower reoperation rate (6.3% vs. 8.6%; OR 0.67; p = 0.02), lower revision rate for implant-related causes (0.7% vs. 1.9%; OR 0.32; p = 0.01), and shorter LOS (mean difference: -0.34 days; p = 0.01). Conclusion: RA-PFJA offers excellent functional outcomes, effective pain relief, and lower revision and complication rates at short to mid-term follow-up. While promising, further high-quality studies are needed to assess long-term results and cost-effectiveness. As robotic systems become more widespread, continued innovation and comparative research will be critical to define their role in orthopaedic surgery.