Robotic surgery: a review of methodological efficacy in total knee arthroplasty as of 2026

Abstract

To date, the integration of computer technologies into clinical medicine has improved the precision and speed of various diagnostic and surgical interventions. This is particularly evident in total knee arthroplasty (TKA)–an effective surgical treatment for late-stage knee osteoarthritis, a progressive musculoskeletal condition. Over the past half-century, continuous advancements in diagnostic capabilities and joint replacement technologies have driven an increase in the volume of these procedures while reducing postoperative complication rates. A further increase in the frequency of total joint replacement surgeries is projected. Despite documented improvements in patient quality of life following major lower extremity arthroplasty (both hip and knee), approximately 30% of patients express dissatisfaction with their outcomes. This sub-optimal satisfaction rate is primarily attributed to precision errors during implant positioning and alignment. Achieving optimal outcomes in knee arthroplasty mandates adherence to surgical protocols, adequate surgical skills, and high accuracy in femoral and tibial bone resections. Proper implant seating depth, accurate component rotation, and anatomical alignment are critical to ensuring optimal load distribution across the host bone interfaces and endoprosthesis components. Inaccurate bone cuts–in terms of both resection height and inclination angles–can lead to component instability, joint stiffness, and persistent postoperative pain. Conventional manual instrumentation and navigation techniques do not consistently achieve accurate resection. The reliance on manual methods introduces a risk of human error, which can affect the success of the surgical treatment. Objective. To investigate the clinical strengths and limitations of various robotassisted surgical systems, evaluate the current state of technological development in this field, and compare their efficacy against traditional manual navigation systems.