Purpose Our systematic review and meta-analysis sought to assess how technology-assistance impacts (1) post-operative pain and (2) opioid use in patients undergoing primary total knee arthroplasty (TKA). Methods Four online databases were queried for studies published up to October 2021 that reported on pain and opioid usage between technology-assisted and manual TKA (mTKA) patients. Mantel-Haenszel (M-H) models were utilized to calculate pooled mean diference (MDs) and 95% conidence interval (CIs). Subgroup analyses were conducted to isolate robotic-arm assisted (RAA) and computed-assisted navigation (CAN) cohorts. Risk of bias was assessed for all included non-randomized studies with the Methodological Index for Non-Randomized Studies (MINORS) tool. For the randomized control trials included in our study, the Detsky scale was applied. Results Our analysis included 31 studies, reporting on a total of 761,300 TKAs (mTKA: n = 753,554; Computer-Assisted Navigation (CAN): n = 1,309; Robotic-Arm Assisted (RAA): n = 6437). No diferences were demonstrated when evaluating WOMAC (MD: 0.00, 95% CI − 0.69 to 0.69; p = 1.00), KSS (MD: 0.01, 95% CI − 1.46 to 1.49; p = 0.99), KOOS (MD − 2.91, 95% CI − 6.17 to 0.34; p = 0.08), and VAS (MD − 0.54, 95% CI − 1.01 to − 0.007; p = 0.02) pain scores between cohorts. There was mixed evidence regarding how opioid consumption difered between TKA techniques. Conclusion The present analysis demonstrated no diference in terms of pain across a variety of utilized patient-reported pain measurements. However, there were mixed results regarding how opioid consumption varied between manual and technology-assisted cohorts, particularly in the immediate post-operative period. Level of evidence III.