Background: Total knee arthroplasty (TKA) demonstrates excellent durability using jig-based manual techniques (manual TKA [mTKA]), but significant rates of dissatisfaction remain. Modifications of mTKA techniques and TKA implant designs to improve outcomes have had minimal success. Studies comparing relative outcomes of mTKA and robotic-assisted TKA (raTKA) are limited. Purpose: This study sought to compare outcomes of mTKA and raTKA in patients at a single institution. Methods: We retrospectively reviewed all primary TKAs performed by 1 surgeon from 2015 to 2017. In all, 139 consecutive mTKAs (2015-2016) and 148 consecutive raTKAs (2016-2017) were included. No cases were excluded. Patient demographics, complications, readmission rates, and clinical and patient-reported outcomes were compared at a minimum of 1-year follow-up. A post hoc student t test and Pearson χ² test were used for continuous and categorical data. Results: We found that mTKA patients compared with raTKA patients required significantly longer length of stay (LOS) (1.73 vs 1.18 days, respectively), greater morphine milligram equivalents consumption (89.6 vs 65.2, respectively), and increased physical therapy (PT) visits (13.0 vs 11.0, respectively) with increased 30-day readmission rates (4.3 vs 0.7%, respectively) that approached significance. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and the University of California at Los Angeles activity score did not differ significantly comparing raTKA with mTKA patients at 1 year. There were no differences in complication rates. Conclusion: Significant early clinical benefits were noted with raTKA, including lower opioid requirements, shorter LOS, and fewer PT visits when compared with mTKA. A reduction in 30-day readmission rates was noted with raTKA that was not significant. Excellent clinical results with similar patient-reported outcomes were noted in both groups at 1-year follow-up. Further prospective investigations at longer follow-up intervals comparing these techniques are warranted.

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