Total knee arthroplasty continues to evolve as surgeons seek to improve functional outcomes, durability and patient satisfaction. While implant design and perioperative protocols have advanced, alignment strategy remains a critical factor influencing long-term success.
According to Alexander van der Ven, M.D., orthopedic surgeon with Baptist Health Orthopedic Care, robotic-assisted technology is reshaping how surgeons approach knee replacement by enabling more personalized alignment, precise execution and reproducible results.
Knee Arthritis Is Not a Uniform Disease
Even cases that appear routine can reflect meaningful anatomic and biomechanical variation. Patients present with differing coronal alignment patterns, ligament balance profiles and joint line orientations, shaped by years of functional loading.
Alexander van der Ven, M.D.,
Historically, traditional knee replacement techniques have aimed to correct all knees to a neutral mechanical alignment. However, large alignment datasets show that only a minority of patients naturally fall into this category. Most have constitutional varus or valgus alignment that may be physiologic rather than pathologic.
“Most patients don’t come in with a neutral knee,” Dr. van der Ven says. “Robotic planning helps us recognize those differences and make alignment decisions based on the patient in front of us, rather than forcing every knee into the same model.”
Robotic-assisted platforms allow surgeons to account for this variability and tailor reconstruction to a patient’s native anatomy rather than applying a one-size-fits-all correction.
Why Navigation Alone Fell Short
Earlier navigation systems improved alignment accuracy but failed to consistently demonstrate improvements in pain, function or implant longevity. As a result, adoption remained limited, particularly in the United States.
Dr. van der Ven notes that navigation reinforced outdated assumptions about knee alignment. While precision improved, decisions were still based on generalized targets that did not reflect individual anatomy. Without personalization, greater accuracy alone did not translate into better outcomes.
Alignment Classification Changed Surgical Thinking
Modern alignment classification systems helped formalize what many surgeons had long observed clinically: knees are shaped differently, and alignment targets should reflect that diversity.
Robotic assistance enables surgeons to evaluate a patient’s alignment and joint line orientation in real time and adjust surgical planning accordingly. This approach supports recreating functional anatomy rather than forcing the knee into a neutral construct, which may reduce unnecessary soft tissue releases and improve balance throughout the range of motion.
Improving Reproducibility in the Operating Room
From a technical perspective, CT-based robotic platforms streamline multiple steps that are traditionally prone to variability. Preoperative imaging reduces reliance on manual registration, while robotic guidance eliminates cutting blocks and visual estimation.
These capabilities may be particularly beneficial for:
- Complex deformities
- Patients with prior surgery or altered anatomy
- High-volume practices seeking consistency across cases
Robotic execution allows surgeons to make fine-tuned adjustments intraoperatively, including small alignment changes that are difficult to achieve reliably with conventional instrumentation.
Implications for Cementless Knee Replacement
As cementless fixation gains traction, surgical accuracy becomes increasingly important. Cemented implants can compensate for minor inconsistencies through the cement mantle, while cementless systems rely on precise bone preparation and implant positioning.
Robotic assistance supports the accuracy required for cementless knees by enabling controlled, reproducible cuts and alignment, potentially improving fixation and long-term survivorship in appropriately selected patients.
Recovery and Care Pathway Considerations
More precise alignment and reduced soft-tissue disruption may influence early recovery. Surgeons are observing trends toward less swelling, improved early motion and more predictable rehabilitation progression in select patients.
These factors may allow for streamlined postoperative protocols that prioritize swelling control, early mobilization and functional recovery rather than prolonged restriction.
Looking Ahead
As knee replacement continues to evolve, alignment strategy and surgical precision are expected to play an increasingly important role in outcomes and implant durability.
“Robotic assistance is changing how we think about knee replacement,” Dr. van der Ven says. “It allows us to better understand a patient’s native anatomy, reduce variability in surgery and make more informed decisions that may improve function and longevity over time.”
Advances in robotic platforms, combined with growing alignment data and emerging analytic tools, are likely to further refine patient selection, surgical planning and postoperative care pathways — particularly as cementless fixation and value-based care models continue to expand.