144 elderly patients undergoing total knee arthroplasty were randomized to receive robotic-assisted TKA (rTKA; n=72) or conventional TKA (cTKA; n=72). Patients were then further divided into those with a Geriatric Nutritional Risk Index (GNRI) ≤100 or >100. Outcomes of interest were postoperative hip-knee-ankle (HKA) angle deviation, Knee Society Score (KSS), visual analog scale (VAS) for pain, coronal tibial component angle (CTCA), coronal femoral component angle (CFCA), sagittal tibial component angle (STCA), and sagittal femoral component angle (SFCA). Outcomes were assessed up to 12 weeks postoperatively. Overall, the results revealed that the RA-TKA group had significantly lower HKA angle deviations compared to the conventional TKA group, particularly among those with a GNRI ≤ 100. The study concluded that RA-TKA offers more precise alignment and better clinical outcomes in malnourished elderly patients, suggesting its potential benefit over conventional TKA in this subgroup.