This study compared the efficacy and safety of MAKO robot-assisted total knee arthroplasty (MA-TKA) with conventional manual total knee arthroplasty (CM-TKA) in patients with end-stage knee osteoarthritis. A retrospective analysis of 22 patients who underwent MA-TKA and 26 patients who underwent CM-TKA from April 2023 to July 2023 was conducted. Radiographic parameters, clinical scores, and postoperative complications were compared between the two groups. In terms of radiographic outcomes, the MA-TKA group showed significantly lower LDFA and HKA values at one month postoperatively compared to the CM-TKA group. At one month follow-up, 86.4% of MA-TKA patients had an HKA less than 3°, compared to 76.9% in the CM-TKA group. Clinically, VAS scores at 24, 48, and 72 hours postoperatively were lower in the MA-TKA group, both at rest and during activity. At one and three months postoperatively, AKSS Function Scores and FJS-12 scores were significantly higher in the MA-TKA group. No complications occurred in the MA-TKA group, while one patient in the CM-TKA group experienced postoperative knee stiffness, which resolved after physical therapy. The study concluded that MAKO robot-assisted TKA demonstrates better short-term clinical efficacy, achieves better alignment planning, and maintains good safety compared to conventional manual TKA. The MAKO robot improves surgical precision, reduces postoperative pain, and enhances functional recovery. It also minimizes damage to soft tissues and reduces the risk of complications. However, the study had limitations, including a small sample size and short follow-up period. Future large-scale, multicenter, long-term studies are needed to confirm these findings.This study compared the efficacy and safety of MAKO robot-assisted total knee arthroplasty (MA-TKA) with conventional manual total knee arthroplasty (CM-TKA) in patients with end-stage knee osteoarthritis. A retrospective analysis of 22 patients who underwent MA-TKA and 26 patients who underwent CM-TKA from April 2023 to July 2023 was conducted. Radiographic parameters, clinical scores, and postoperative complications were compared between the two groups. In terms of radiographic outcomes, the MA-TKA group showed significantly lower LDFA and HKA values at one month postoperatively compared to the CM-TKA group. At one month follow-up, 86.4% of MA-TKA patients had an HKA less than 3°, compared to 76.9% in the CM-TKA group. Clinically, VAS scores at 24, 48, and 72 hours postoperatively were lower in the MA-TKA group, both at rest and during activity. At one and three months postoperatively, AKSS Function Scores and FJS-12 scores were significantly higher in the MA-TKA group. No complications occurred in the MA-TKA group, while one patient in the CM-TKA group experienced postoperative knee stiffness, which resolved after physical therapy. The study concluded that MAKO robot-assisted TKA demonstrates better short-term clinical efficacy, achieves better alignment planning, and maintains good safety compared to conventional manual TKA. The MAKO robot improves surgical precision, reduces postoperative pain, and enhances functional recovery. It also minimizes damage to soft tissues and reduces the risk of complications. However, the study had limitations, including a small sample size and short follow-up period. Future large-scale, multicenter, long-term studies are needed to confirm these findings.