The aim of this systematic review was to present and assess the quality of evidence for learning curve, component positioning, functional outcomes and implant survivorship for image-free hand-held robotic-assisted knee arthroplasty. Searches of PubMed and Google Scholar were performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The criteria for inclusion was any published full-text article or abstract assessing image-free hand-held robotic knee arthroplasty and reporting learning curve, implant positioning, functional outcome or implant survival for clinical or non-clinical studies. There were 22 studies included. Five studies reported the learning curve: all were for unicompartmental knee arthroplasty (UKA) – no learning curve for accuracy, operative time was reduced after five to 10 cases and a steady surgical time was achieved after eight cases. There were 16 studies reporting accuracy: rate of outliers was halved, higher rate of joint line and mechanical axis restoration, supported by low root mean square error values. Six studies reported functional outcome: all for UKA, improvement at six to 52 weeks, no difference from manual UKA except when assessed for lateral UKA which showed improved clinical outcomes. Two studies reported survivorship: one reported an unadjusted revision rate of 7% at 20 months for medial UKA and the other found a 99% two-year survival rate for UKA. There was evidence to support more accurate implant positioning for UKA, but whether this is related to superior functional outcomes or improved implant survivorship was not clear and further studies are required. Cite this article: EFORT Open Rev 2020;5:319-326. DOI: 10.1302/2058-5241.5.190065

Purpose: Patient satisfaction regarding their hip replacement is often assumed to be directly linked to functional outcomes. We led this study to answer 2 questions: (1) what is the level of patient satisfaction, function, and quality of life after primary total hip replacement (THR); and (2) what is the relationship between patient satisfaction and functional and quality of life PROMs after THR? Methods: We led a retrospective study using our institutional registry of prospectively and consecutively collected data on patients after primary THR undertaken between 2004 and 2017. We included 6710 patients with a complete 2-year set of follow-up data for Oxford Hip Score (OHS) (for assessing patient’s function), EQ-5D (for assessing patient’s quality of life) and satisfaction PROM scores. Results: There was a significant improvement in all OHS and EQ-5D scores from preoperative level, and the mean postoperative satisfaction score was 89/100. We found moderate positive correlations between the patients’ outcome satisfaction VAS score and OHS (r = 0.665) and EQ-5D (r = 0.554). Conclusions: THR is a successful procedure generating high levels of patient function and satisfaction. Because patients’ OHS and EQ-5D scores may be influenced by comorbidities, those scores are of poor predictive value in estimating patient satisfaction, and therefore should not be used as a surrogate to determine the success of the THR procedure.