Current developments in robotic assistance technology for total knee arthroplasty: a comprehensive overview

Authors: Hongli Zhang et al. (2025)

Link: https://josr-online.biomedcentral.com/articles/10.1186/s13018-025-05490-z

Background Information:

Knee osteoarthritis causes chronic pain, swelling, and trouble moving—often leading patients to need total knee replacement surgery. As joint replacements become more common, new technologies like robotic and computer‑assisted systems are being developed to improve the precision of these operations. These systems aim to better align implants, balance soft tissues, and replicate the patient's natural anatomy, potentially improving long-term outcomes and reducing complications.

Purpose of the Study:

This review was designed to give a full picture of the latest robotic assistance technologies used in total knee arthroplasty (TKA). It examines different robotic systems—ranging from fully autonomous to semi-autonomous and handheld platforms—and describes how they work, compares them to traditional manual techniques, discusses their learning curves, and outlines the benefits and challenges of robotic-assisted surgery.

Methods and Data Analysis:

The authors conducted a comprehensive literature review, scanning studies from PubMed and Web of Science through late 2024. They analyzed various aspects of robotic TKAs such as implant positioning accuracy, soft tissue balancing, limb alignment, surgical time, complication rates, and required surgeon training. They synthesized results from randomized controlled trials, prospective cohort studies, meta-analyses, and registry data, as well as early reports on new systems like the ROSA® and SkyWalker robots.

Key Findings and Conclusions:

Robotic-assisted TKA consistently offers more accurate implant alignment and restores joint alignment closer to natural anatomy compared to manual techniques. Some studies show faster recovery, shorter hospital stays, and reduced opioid use postoperatively, thanks to better precision and less tissue trauma. However, improvements in functional outcomes—like pain relief and mobility scores—are mixed, and robotic methods often take longer to learn and initially lengthen surgery time. The technology appears safe, but evidence on long-term benefits, complication rates, and cost-effectiveness remains inconclusive.

Applications & Limitations:

Robotic TKA shows great potential for enhancing surgical accuracy and improving patient recovery. Surgeons may benefit from reduced technical variability and patients may experience quicker rehabilitation. However, high equipment costs, additional training requirements, and uncertain long-term clinical advantages are challenges. Future priorities include longer-term studies on outcomes and complications, cost-benefit evaluations, and development of more intuitive and efficient robotic systems. Tailoring robotic techniques to individual patient anatomy and “functional alignment” may increase their value in routine care.