Progress in Total Knee Arthroplasty

Dear Colleagues,

Knee osteoarthritis is a leading cause of pain and disability worldwide; it carries several implications for patients’ quality of life and for healthcare systems in terms of costs and long-term care requirements. Total knee arthroplasty (TKA) has traditionally been a highly effective solution for end-stage osteoarthritis, offering reliable pain relief and functional improvement. However, despite overall success, a significant proportion of patients report persistent pain, dissatisfaction, or suboptimal functional outcomes postoperatively, highlighting the need for a deeper understanding of knee biomechanics and personalized surgical strategies.

There have been substantial advances in knee arthroplasty in recent years. The introduction of new classification systems, such as the Coronal Plane Alignment of the Knee (CPAK), has enabled surgeons to better categorize preoperative knee phenotypes, tailor implant positioning, and predict postoperative outcomes. Beyond traditional mechanical alignment, there is growing interest in kinematic and functional alignment approaches, which aim to restore the patient’s native joint line, ligament tension, and overall limb kinematics. These strategies recognize the heterogeneity of knee anatomy and the limitations of a one-size-fits-all approach, offering the potential for improved patient satisfaction and more natural knee function. Similarly, robot-assisted surgery has transformed the technical execution of TKA. Robotic platforms allow accurate bone resection, optimal implant positioning, and real-time intraoperative feedback, minimizing alignment errors and soft tissue imbalance. Emerging evidence suggests that robot-assisted TKA can reduce outliers in component placement, improve early functional outcomes, and potentially enhance long-term survivorship. Coupled with patient-specific instrumentation and preoperative planning software, these tools facilitate personalized arthroplasty that considers individual anatomy, alignment targets, and functional demands.

Furthermore, modern TKA research emphasizes a multifactorial understanding of postoperative function, integrating implant design, alignment philosophy, soft tissue balancing, and rehabilitation protocols. Novel implant geometries and advanced bearing surfaces aim to mimic native knee kinematics more closely and ensure better fixation, while accelerated and targeted physiotherapy programs focus on restoring strength, proprioception, and gait patterns. The interplay between surgical precision, alignment strategy, and patient-specific biomechanics is increasingly recognized as critical to optimizing long-term outcomes.

The purpose of this Special Issue is to explore the latest advances in knee arthroplasty as follows:

• Topic 1: classification systems and alignment philosophies;
• Topic 2: different robotic technologies and personalized surgical strategies;
• Topic 3: innovations in implant design and cementless solutions;
• Topic 4: satisfaction and long-term survivorship.

By highlighting these cutting-edge approaches, this Special Issue aims to provide a comprehensive overview of the evolving landscape of total knee arthroplasty and to guide future research and clinical practice.

Dr. Pierangelo Za
Dr. Giuseppe Papalia
Guest Editors

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• total knee replacement
• mechanical alignment
• kinematic alignment
• functional alignment
• robot-assisted surgery
• computer navigation
• implant design
• personalized arthroplasty
• rehabilitation