The Evolution of CT-Based Robotic Systems in Total Knee Arthroplasty: From Precision Tools to Intelligent Surgical...

Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures; however, achieving consistent implant alignment, soft-tissue balance, and optimal patient satisfaction remains challenging. These limitations have driven the evolution of surgical technologies from conventional instrumentation and computer navigation to Computed Tomography (CT)-based robotic systems. Over the past three decades, CT-based robotic systems have evolved from early autonomous platforms to contemporary technologies that include both semi-active haptic-guided systems and next-generation autonomous robotic platforms, enabling patient-specific planning, precise bone preparation, and reproducible surgical execution. Contemporary robotic platforms have further expanded the role of robotics beyond precision toward individualized alignment and data-driven decision-making. In this editorial, we review the major milestones in the development of CT-based robotic systems, summarize the available clinical evidence supporting their use, and highlight the expanding global and Indian experience. We also discuss emerging innovations, including artificial intelligence (AI), machine learning (ML), predictive analytics, and digital surgical ecosystems, that are expected to further advance precision, personalization, and value-based care in knee arthroplasty.