Future Considerations

Total knee arthroplasty has evolved both in design and instrumentation over the last several decades. The original debate about whether to retain the PCL has now moved to guided motion knee designs and alternative alignment. While PS and CR designs still dominate the world market, guided motion knees are gaining greater interest. Mechanical alignment has been the gold standard but is now challenged by kinematic and functional approaches. Innovative technology, including robotic surgery, sensors, and augmented reality, has influenced surgical technique with claims of greater surgical accuracy and ultimate clinical outcomes. The arrival of smart implants with embedded sensor technology has the potential to provide the quantitative in vivo data to improve postoperative recovery. With the acquired knowledge, improvements in our understanding of knee anatomy and biomechanics are suggesting ways of improving outcomes and potentially patient satisfaction. Applying this knowledge to implant designs that replicate the anatomy of the knee and kinematics, along with more precise surgical techniques with innovative technology will be the future of TKA.