The future of robotic TKA surgery - a critical review but positive outlook

Abstract

Background: Total knee arthroplasty (TKA) is a rapidly expanding sub-segment of orthopedic surgery. While computer-assisted surgery (CAS) and robotic-assisted surgery (RAS) have been developed to enhance surgical precision and reproducibility, the definitive clinical superiority of these technologies remains a subject of significant debate within the orthopedic community. Objective: This review evaluates the current state and future trajectories of robotic-assisted systems in knee arthroplasty, addressing existing technological limitations, cost-effectiveness, and the transition toward data-driven surgical planning. Key Points: Robotic platforms demonstrate superior accuracy in bone preparation, component positioning, and ligament balancing compared to conventional manual instrumentation, particularly for less experienced surgeons. However, widespread adoption is hindered by high capital costs, bulky hardware, and potential pin-site complications. Current research indicates that while CAS technologies have reached a maturity plateau, RAS publications continue to increase. The future of the field involves integrating augmented reality to eliminate line-of-sight issues and utilizing collaborative intelligence. This "closed-loop" approach aims to transition RAS from a tool for precise execution to a predictive system that utilizes large-scale perioperative data and machine learning to determine patient-specific alignment targets and optimize functional outcomes. Conclusion: Although RAS provides highly reproducible mechanical execution, its long-term clinical value depends on defining optimal personalized alignment goals. Surgeons must focus on integrating multi-dimensional data to justify the cost-efficiency of these technologies through improved patient-reported outcome measures and reduced revision rates.

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