Title : A comprehensive review of operative considerations, surgical techniques, outcomes, and future perspectives in total knee arthroplasty
Abstract:
Objectives: Total knee arthroplasty (TKA) remains the gold-standard surgical treatment for end-stage knee osteoarthritis (OA). With TKA numbers rising, this review summarises its development, implant options, perioperative care and the technologies likely to shape its future.
Methods: We carried out a narrative review using PubMed, MEDLINE and Google Scholar. We included randomised controlled trials, clinical trials, meta-analyses and systematic reviews published in English over the past 15 years in human subjects aged 45 and over. Key comparisons were cemented versus cementless fixation, mobile versus fixed bearing, posterior-stabilised versus ultra-congruent design, and single-radius versus multi-radius femoral design, alongside alignment strategies, preoperative optimisation, robotic and sensor-assisted surgery, rehabilitation and complications.
Results: Cemented fixation remains standard, though cementless TKA may give comparable results in selected younger patients. Mobile-bearing and newer medial-pivot designs may offer small functional gains, without consistent improvement in revision rates or implant survival. Robotic and sensor-assisted systems improve implant positioning, alignment and soft-tissue balancing, and may aid early recovery, cut alignment errors and reduce blood loss, but these gains have not reliably translated into better long-term function, complications or survival. Preoperative optimisation, patient education and rehabilitation remain key to recovery, and an early functional advantage is often seen with minimally invasive approaches. AI-assisted planning, outpatient arthroplasty and patient-specific 3D-printed implants show promise but are limited by cost, access and a lack of long-term validation.
Conclusion: TKA continues to deliver excellent results while evolving through better technique, implant design and perioperative care. Current innovations improve precision and some short-term outcomes, but their long-term clinical value and cost-effectiveness stay uncertain. More multicentre studies with standardised outcomes and longer follow-up are needed before wider adoption.
