Aim: The primary objective of this study was to determine the accuracy and precision of component positioning of the ROSA Robotic System for total knee arthroplasty (TKA). Methods: A PRISMA systematic review was conducted using four electronic databases (MEDLINE, EMBASE, Pubmed and Cochrane Library) without date restriction. The criteria for inclusion were published research articles evaluating the accuracy of component positioning, learning curve, prosthesis alignment, complications, and functional outcomes in adults who underwent robotic-assisted TKA. The NIH Quality Assessment Tool was used to evaluate the quality of all included studies. Results: Total of 26 studies were identified, of which 17 met the inclusion criteria. Nine reported on the accuracy and precision of component positioning. Pooled accuracy and precision were less than 1 degree and 2 degrees for all coronal and sagittal plane parameters. All studies reported decreased percentage of outliers (>3 degrees) when ROSA-assisted TKA was compared to conventional TKA. 4 studies assessing functional outcomes reported significantly better functional scores with ROSA-assisted TKA. One study reported a significant difference in knee range of motion at one year after surgery compared with conventional TKA (119.4 degrees vs 107.1 degrees (p<0.0001)). There was no difference in overall complication rates between the groups. Conclusion: The ROSA platform for TKA is both highly accurate and precise when analyzed at various time points including postoperative standing radiographs. This reduced the number of outliers when compared to conventional TKA and resulted in improved patient-reported outcomes within 1 year of surgery with no increased risks of complications.