Background <p>Total knee arthroplasty (TKA) in the presence of coronal (varus/valgus) and sagittal (fixed flexion deformity [FFD]/hyperextension) deformities presents anatomical and technical challenges. This study evaluates the accuracy of fully automated robotic-assisted TKA (RATKA) using the Cuvis Joint Robot in Indian patients with varying deformities.</p> Methods <p>A single-center retrospective study was conducted on 234 patients undergoing RATKA with the Cuvis Joint Robot for primary osteoarthritis with varus or valgus deformities. Patients with prior manual TKA, additional deformities, or revision/infected TKA were excluded. Preoperative 3D CT-based planning guided surgery. Postoperative coronal and sagittal alignment, correction rates, and implant positioning accuracy were analyzed.</p> Results <p>Data from 142 bilateral and 92 unilateral TKA cases were reviewed. RATKA achieved accurate alignment correction in both planes. Neutral coronal alignment was attained in all mild-to-moderate varus (&lt; 7°) and 47% of severe varus (≥ 7°) cases, with an additional 26% corrected within 0°–4° of neutral. All valgus deformities (≥ 7°) were corrected to near-neutral (mean residual 2°, range 0–3°). In knees with FFD &lt; 7°, full correction to neutral was achieved; in FFD 7°–14°, 50% were corrected to within ± 3° of neutral. Scanogram analysis showed preoperative varus/valgus correction from 9.7° to 1.8° in unilateral and from 10.1° to 1.7° in bilateral cases.</p> Conclusions <p>Fully automated RATKA using the Cuvis Joint Robot demonstrated high precision in correcting coronal and sagittal deformities with minimal soft tissue release. This approach may improve implant positioning, alignment, and potentially long-term functional outcomes. Further research is warranted to evaluate durability.</p>