Robotic-assisted total knee arthroplasty is associated with more favorable early patient-reported outcomes and may attenuate experience-related outcome differences.

This study compared early patient-reported outcomes after robotic-assisted total knee arthroplasty (R-TKA) and manual total knee arthroplasty (M-TKA) and explored the influence of surgeon experience. We enrolled 430 patients undergoing R-TKA (n = 221) or M-TKA (n = 209). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) was assessed preoperatively and at 3, 6, and 12 months. Between-group differences in KOOS JR and achievement of the minimal detectable change (MDC), minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) were evaluated. Primary analyses used repeated-measures linear mixed-effects models with covariate adjustment. Surgeon experience was examined in a post hoc exploratory analysis. At 3 months, adjusted KOOS JR scores were higher in the R-TKA group than in the M-TKA group (difference, 4.71 points; 95% CI, 2.35-7.08; P < 0.001). The difference decreased at 6 months (3.13 points; P = 0.010) and was not significant at 12 months (0.89 points; P = 0.461). At 3 months, the R-TKA group had higher achievement rates of MDC, MCID, and SCB (all Holm-adjusted P ≤ 0.05). Post hoc analysis showed the greatest benefit of R-TKA among junior surgeons at 3 months (+ 6.48 points; Holm-adjusted P = 0.003), with junior surgeons using R-TKA achieving outcomes comparable to senior surgeons. R-TKA was associated with more favorable early patient-reported outcomes and higher rates of clinically meaningful improvement. Exploratory analysis suggested a greater early benefit among junior surgeons, potentially attenuating experience-related outcome differences.