Applications of Exoskeleton Robots for Rehabilitation in Patients with Knee Osteoarthritis: A Scoping Review

Abstract

Background: Exoskeleton robots have emerged as a promising rehabilitation technology for patients with knee osteoarthritis (KOA). However, existing studies vary in their clinical applications and outcome assessments, and the available evidence has not yet been systematically mapped. This scoping review aimed to systematically map the current applications of exoskeleton robots in KOA rehabilitation, characterize the existing literature, and identify gaps in the current evidence base. Methods: This review followed the PRISMA-ScR guidelines to conduct a scoping review of the literature on the effectiveness of exoskeleton devices in the rehabilitation of patients with knee osteoarthritis. We searched PubMed, Scopus, the Cochrane Library, Embase, Web of Science, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), the Wanfang Data Knowledge Service Platform, and the Chinese Science and Technology Journal Database (VIP) for studies published from database inception to September 1, 2026. Data were extracted using a standardized template and synthesized through content analysis. Results: Of the 1,709 records retrieved from the nine databases, 13 studies were ultimately included. Of these, 11 investigated exoskeleton-assisted rehabilitation during the early postoperative period following total knee arthroplasty (TKA), while two involved patients with KOA receiving conservative treatment. The devices evaluated included HAL, HWA, Keeogo, lightweight pneumatic exoskeletons, and other hybrid or modified knee exoskeletons. The outcomes assessed primarily covered pain, knee function and range of motion, gait and walking ability, lower-limb muscle strength and joint kinetics, quality of life, and device safety. Although some studies reported favorable effects of exoskeleton-assisted rehabilitation on relevant outcomes, considerable heterogeneity existed across studies, and the available evidence remains limited. Further research is therefore needed to establish the overall clinical effectiveness of exoskeleton-assisted rehabilitation in patients with KOA. Conclusion: Exoskeleton robots show potential for rehabilitation in patients with KOA and may help alleviate pain and improve knee function and walking ability, with a generally favorable safety profile. However, the current evidence remains limited. Further high-quality clinical studies are needed to clarify their clinical efficacy, identify appropriate target populations, and evaluate their long-term effects.