From Vision to Reality: the Clinical Experience and Future of Knee Robotic Surgery

Background: Robotic-assisted surgery represents an evolution in computer-assisted orthopedic procedures, aiming to enhance the precision and reproducibility of bone preparation in lower limb arthroplasty. While traditional robotic systems often require preoperative computed tomography and bulky equipment, image-free systems utilizing bone-morphing technology have emerged to streamline the surgical workflow and eliminate preoperative radiation exposure.

Objective: This article describes the clinical application, technical implementation, and surgical outcomes of the Navio® image-free robotic-assisted system across various knee arthroplasty indications.

Key Points: The system utilizes an infrared camera, tracking arrays, and a handheld robotic bur with automatic feedback to ensure bone resection remains within planned boundaries. The workflow integrates dynamic ligament balancing and 3D anatomical mapping to optimize implant positioning in unicompartmental (UKA), patellofemoral (PFA), and total knee arthroplasty (TKA). Clinical data indicate that robotic assistance achieves superior joint line restoration and more accurate radiological positioning compared to conventional techniques. Furthermore, studies report a lower revision rate for lateral UKA and a significantly faster return to sporting activities, such as cycling and skiing, following robotic-assisted procedures. The technology also facilitates complex indications, including bicruciate-retaining TKA and combined UKA with anterior cruciate ligament reconstruction, by providing precise control over tibial slope and gap symmetry.

Conclusion: Image-free robotic assistance provides a highly accurate, reproducible method for knee arthroplasty that improves component alignment and soft tissue balancing. These technical advantages translate into enhanced functional recovery and reduced complication rates without the need for preoperative imaging.