Robotic Knee Surgery: What’s in a Name?

Background: Robotic-assisted total knee arthroplasty (TKA) has seen rapid clinical adoption driven by technological advancements, evolving alignment philosophies, and industry marketing. Despite this growth, the transition from conventional surgical navigation to robotic platforms necessitates a critical evaluation of their technical utility, cost-effectiveness, and clinical efficacy.

Objective: This review aims to analyze the current landscape of robotic knee surgery by examining the various technological architectures, levels of intraoperative assistance, and the clinical implications of integrating these systems into orthopedic practice.

Key Points: Robotic systems are categorized by their reliance on preoperative imaging (CT/MRI) versus intraoperative mapping, with image-based platforms offering superior rotational landmark definition and boundary control. Mechanical assistance ranges from autonomous bone resection to haptic-guided or passive boundary systems. While robotics may enhance precision and soft-tissue protection, significant challenges remain regarding the reliability of intraoperative gap analysis and the lack of standardized data collection. Current literature is characterized by a high prevalence of financial conflicts of interest and a lack of long-term, industry-independent randomized controlled trials. Furthermore, while a learning curve exists for surgical efficiency, most platforms are currently restricted to specific implant brands, impacting their broader cost-effectiveness.

Conclusion: Robotic technology in TKA offers potential improvements in component positioning and soft-tissue preservation; however, current systems possess inherent technical limitations. Future advancements require independent clinical validation and improved integration of real-time ligament balancing to translate technical precision into superior long-term patient outcomes.