Title : Robotic-assisted Kinematic Alignment(KA) in Total Knee Arthroplasty (TKA)
Abstract:
Background: Personalized alignment strategies in Total Knee Arthroplasty (TKA), such as Kinematic Alignment (KA), aim to restore the patient’s native anatomical knee position prior to disease onset. Robotic-assisted systems have enhanced the precision and reproducibility of KA techniques; however, controversies remain regarding implant survivorship, safety thresholds, cost-effectiveness, and global adoption.
Aim: This narrative review summarizes the current evidence on robotic-assisted KA in TKA, addressing the technical basis, clinical outcomes, and ongoing controversies. It also explores regional perspectives on the implementation of robotic-assisted KA across Europe and Asia.
Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar for peer-reviewed articles published between 2015 and 2025 using keywords related to robotic-assisted TKA, KA techniques, and alignment controversies. Grey literature including professional society statements and joint registry reports were also reviewed.
Results: Robotic-assisted TKA improves implant positioning accuracy and allows for personalized alignment strategies. Limited short-term data suggest improved functional recovery and patient-reported outcomes with robotic-assisted KA compared to conventional methods. However, evidence supporting superior long-term outcomes over mechanical alignment (MA) is scarce, and cost-effectiveness remains inadequately demonstrated. National joint registries in Europe and Asia have begun to capture data on robotic-assisted KA usage, offering opportunities for future longitudinal analyses.
Conclusion: Robotic-assisted KA represents a promising personalized approach in TKA, but high-quality prospective trials are required to confirm its impact on long-term implant survivorship and patient outcomes. Future research should also evaluate the clinical utility and economic value of incorporating robotic-assisted KA into standard TKA practice.
