Seven randomized controlled trials including 1942 patients with primary osteoarthritis were included in this systematic review and meta-analysis comparing robotic-assisted total knee arthroplasty (RTKA) vs. conventional total knee arthroplasty (CTKA). Pooled outcomes of interest included post-operative alignment, knee range of motion, knee society scores (clinical and functional), Hospital of Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index, and complications. Pooled results indicated that RTKA offered superior post-operative anatomical and mechanical alignment compared to CTKA. However, clinical and functional outcomes and complication rates were similar between the two methods. The main findings suggest that while RTKA provides better alignment, it does not significantly improve overall clinical outcomes.