Robotic arm-assisted patellofemoral joint arthroplasty achieves good short-term survival and functional outcomes: A systematic review and meta-analysis

Robotic arm-assisted (RA) surgery is associated with improved accuracy and outcomes in medial unicompartmental knee arthroplasty, but the role in patellofemoral arthroplasty (PFA) remains less well defined. This review aimed to evaluate the functional outcomes and implant survivorship of RA-PFA. A systematic review of PubMed, Embase and the Cochrane Library was performed in November 2025. All studies reporting clinical outcomes for RA-PFA were included. The primary outcome was survival at final follow-up; secondary outcomes included patient-reported outcomes, reoperation frequency and radiographic outcomes. Meta-analyses of survival and nonconversion reoperation rates, and comparative analyses with other PFA techniques were performed. Eight studies (893 patients; 72.4% female, mean age 56.6 years [SD 7.7]) assessing RA-PFA were included. Survivorship was 93.6% (95% confidence interval [CI]: 91.2-95.8) at a mean follow-up of 3.3 years (SD 1.1). Meta-analysis of studies comparing survivorship of RA-PFA (n = 713) with manual PFA (n = 1580) showed reduced risk of revision for RA-PFA (RR = 0.75, 95% CI = 0.562-0.995, p = 0.048). The wide CI indicate uncertainty around the estimate. No survivorship difference was observed between robotic techniques. No randomised studies were identified. Reporting of PROMs following RA-PFA was limited to three studies (n = 112), all of which demonstrated excellent postoperative functional outcomes, with only one assessing postoperative health-related quality of life. Radiological outcomes and implant positioning were reported in only two studies (n = 66): one reporting improvements in patellar tilt compared with manual PFA following RA-PFA, comparable to other robotic systems, and one reported strong correlations between implant positioning and preoperative templating. RA-PFA achieves good short-term survivorship and functional outcomes that are comparable to manual techniques. However, the small number of available studies, short follow-up and lack of randomised trials preclude definitive conclusions. Level IV, systematic review and meta-analysis.