Enabling technology in total knee arthroplasty: current concepts in 2026

Total knee arthroplasty (TKA) instrumentation and surgical techniques have significantly evolved over the past twenty years from conventional manual tools to including enabling technology, and will continue to advance at an exponential rate. Advancements in TKA technologies were first developed to aid the surgeon in refining surgical planning, improving surgical accuracy, and enhancing decision making. Yet the advancements in TKA technology within the past decade, specifically robotics, have yet to translate into significant clinical improvements for patients. With the goal of improving patient satisfaction and functional outcomes, there is a growing role of enabling technologies in refining alignment strategies for TKA This review comprehensively evaluates the impact of enabling TKA technology. The review discusses the role of enabling technology in 2026, including computer assisted navigation, robotic-assisted navigation (full active vs. semi-active robotic TKA systems), patient-specific instrumentation, intraoperative pressure sensors, augmented and virtual reality technology, 3D printing technology, digital health tools, and artificial intelligence applications in TKA. While enabling technologies improve accuracy and intraoperative decision-making, long-term superiority in clinical outcomes is not yet established for many enabling TKA technologies. Additional high-quality studies with long-term follow up are warranted on utilizing enabling technology with long-term follow up on patient reported outcomes, implant survivorship, and cost-effectiveness.