D. Joanna Kim, MD
March 26, 2026
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In part 1, Dr. Varacallo shared his take on manual vs. robotic assisted TJA, now Dr. Kim shares her perspective on approaching TJA through these different techniques.
Manual vs. Robotic Total Knee Arthroplasty: A Resident’s Perspective from the Operating Room
Total knee arthroplasty (TKA), from a resident perspective, is a fascinating intersection of surgical fundamentals and rapidly evolving technology. Over the past decades, robotic-assisted knee replacement has gained increasing attention and adoption. As a trainee who has had the opportunity to observe and assist with both manual and robotic TKAs, having both in our surgical training offer a unique window into how surgical practice is changing.
Manual TKA remains the gold standard in many operating rooms across the world. From a resident’s perspective, manual TKA is where the fundamentals of knee arthroplasty truly become clear. Every step emphasizes core surgical principles: understanding lower extremity alignment, identifying anatomic landmarks, proper positioning of cutting guides, balancing flexion and extension gaps, and achieving stable soft tissue tension. These steps force us to think critically about alignment and implant positioning. Manual TKA also is better in developing the tactile judgment, and it forces us to understand how adjustments can influence final alignment and joint stability.
Though concepts are similar, robotic-assisted knee replacement introduces another dimension to surgical training: real-time data and visualization. Robotic platforms provide structured workflows and real-time intraoperative feedback on parameters such as implant position, bone resection depth, alignment, and ligament balance. This objective and real-time feedback visualized on the screen helps trainees recognize errors and refine technique more quickly. For example, adjusting implant positioning during planning and immediately seeing its effect on gap balance helps with understanding and the adjustments needed. In this way, robotics can act as a powerful educational tool, reinforcing principles that residents are simultaneously learning in manual cases.
In all, robotics can reinforce learning by visualizing concepts that are otherwise abstract. At the same time, it is essential for trainees to learn how to perform the procedure manually. From my perspective as a resident physician, manual and robotic TKA are complementary approaches that are both essential and relevant in our training!
DISCLOSURES: Dr. Kim This individual reported nothing to disclose.
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