Background: There are still a high number of dissatisfied knee arthroplasty patients. This situation has not changed much for decades, despite many innovations focusing on implant longevity and higher procedural precision. In this context, there is a growing discussion on possible systematic errors made in knee arthroplasty, especially regarding the alignment philosophy of the implants.
Objective: It was reported that a more anatomical alignment might result in improved patient outcome. However, current technologies have severe limitations to achieving optimized and individual alignment. In this context, the aim of this manuscript was to assess whether image-based robot-guided knee arthroplasty might represent an opportunity for achieving individualized alignment.
Methods: The literature on this subject was evaluated and analyzed. Furthermore, research projects and expert recommendations were discussed.
Results: The precision of preoperative planning is higher with robotic techniques than with other computer-assisted or manual technologies. In addition, the individual soft tissue situation of the patient is taken into account and the prosthesis position is optimized. This ensures optimum soft tissue balancing and stability of the prosthesis.
Conclusion: Modern robot-assisted systems are the mechanical bridge between imaging and patient. This technique provides objective control over the results produced with alternative alignments. This applies to both the prosthesis position itself and the resulting soft tissue balancing.
Keywords: Image-guided surgery; Knee joint; Robotic surgical procedures; Total knee arthroplasty; Unicompartmental knee arthroplasty.