Abstract
Post-traumatic osteoarthritis (PTOA) following tibial plateau fractures constitutes a demanding indication for total knee arthroplasty (TKA) because of residual deformities, altered joint biomechanics, soft-tissue imbalance, and the potential presence of retained hardware. Conventional TKA in this setting is associated with higher rates of intraoperative complications, suboptimal implant positioning, and increased revision risk. Robotic-assisted (RA) technologies have emerged as potential tools to enhance accuracy, restore alignment, and improve reproducibility in complex knee arthroplasty. The aim of this study is to summarize and critically appraise the current evidence on RA-TKA for PTOA after tibial plateau fractures, highlighting advantages, limitations, and future perspectives. A narrative review was conducted by searching PubMed and Scopus for clinical studies evaluating RA-TKA in the setting of prior tibial plateau fractures. Relevant case series, cohort studies, and comparative analyses were reviewed and synthesized. Preliminary evidence suggests that robotic-assisted TKA may improve the accuracy and reproducibility of component positioning; however, most quantitative accuracy data are derived from primary osteoarthritis cohorts, with limited PTOA-specific evidence currently available. Robotic platforms may also facilitate intraoperative soft-tissue balancing in anatomically distorted knees. However, available literature remains limited to small case series with heterogeneous patient cohorts and short follow-up durations. Functional outcomes and complication rates are inconsistently reported, and robust comparative data are lacking. RA TKA appears to be a promising approach for managing PTOA after tibial plateau fractures. Despite encouraging early results, current evidence is still preliminary. High-quality prospective studies, ideally multicenter with long-term follow-up, are required to substantiate the clinical, functional, and economic benefits of robotics in this challenging population.