Robotic vs Conventional TKR: RACER-Knee (Lancet, 2026)
The largest masked RCT of robotic-arm-assisted TKR to date (339 patients, 10 UK centres, 33 surgeons).
Result: No clinically meaningful difference at 12 months.
Forgotten Joint Score: rTKR 49.2 vs cTKR 50.2 (adj. diff –1.5, 95% CI –7.5 to 4.5)
Similar pain, function, EQ-5D, complications, and adverse events
rTKR: +10.5 min operating time, more precise HKA alignment — but no functional payoff
Cost: rTKR ~£1000 more per patient; only 4% probability of being cost-effective at £30,000/QALY
Takeaway: Better alignment precision ≠ better patient-reported outcomes — at least within the first year. Robotic assistance remains a technology in search of its clinical benefit.
📎 Metcalfe et al., The Lancet, Aug 2026 — doi:10.1016/S0140-6736(26)00986-4
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