Current adoption trends and future perspectives on Robotic-assisted Total Knee Arthroplasty among Flemish knee surgeons

Robotic-assisted Total Knee Arthroplasty (RA-TKA) is increasingly adopted to improve component position, limb alignment and soft tissue balance, potentially enhancing functional outcomes and patient satisfaction. However, long-term clinical benefits over conventional procedures remain unproven and emersion in daily practice remains limited. This study aims to investigate the adaptation rationale, workflow modifications and expectations of Flemish knee surgeons who adopted RA-TKA in their arthroplasty practice. A 28-item Web survey was sent on January 21st, 2025 to 64 Flemish knee surgeons, all members of the Belgian Knee Society. 51 surgeons completed the survey, representing a response rate of 80.0%. The questionnaire addressed demographics, RA-TKA usage, alignment and balancing strategies, and opinions on cost-effectiveness and future trends. Data were analyzed descriptively. Flemish surgeons adopted RA-TKA primarily to enhance operative assessment, component positioning and balance. Only 45% of surgeons expected improved clinical outcomes. Surgical techniques shifted significantly, with 73.0% altering alignment techniques, predominantly from mechanical to (inverse) kinematic alignment (59.0%). The type of constraint changed in 76.0% of surgeons, most commonly toward medial-stabilized (25.0%) and cruciate-retaining (22.0%) inserts. 98.0% support the continued inclusion of manual TKA training for residents. While 69.0% of surgeons considered RA-TKA too expensive, 76.0% expected to achieve cost savings due to reduced revisions. RA-TKA is increasingly integrated into clinical practice by Flemish knee surgeons, influencing alignment philosophy and implant constraint. Despite the high satisfaction rate among RA-TKA users, cost remains a major concern. Furthermore, less than half of the surgeons expected to achieve improved clinical outcomes with the use of RA-TKA.