Increasing research on personalized alignment concepts, robotic-assisted surgery and artificial intelligence in total knee arthroplasty: A bibliometric analysis of the last 10 years in <i>KSSTA</i>.

Onoi, Yuma; Elsheikh, Randa; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Huegli, Rolf; Nowakowski, Andrej Maria; Hirschmann, Michael Tobias · J Exp Orthop · 2026

other · Level V

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Abstract

To evaluate contemporary trends in total knee arthroplasty (TKA) research published in <i>Knee Surgery, Sports Traumatology, Arthroscopy</i> (<i>KSSTA</i>) over the last decade, with a focus on alignment concepts and surgical assistance technologies. <i>KSSTA</i> articles on primary TKA published between 2015 and 2024 were identified through Scopus. After exclusions, 856 articles were analysed. Bibliometric data were extracted and manually classified according to alignment concepts (mechanical [MA], kinematic [KA] or functional [FA]), surgical assistance technologies (manual, navigation, patient-specific instrumentation [PSI] or robotic-assisted surgery), study design and the use of patient-reported outcome measures (PROMs). Analyses and visualizations were performed using R (Bibliometrix) and VOSviewer. Alignment concepts shifted after 2022; KA increased to 40% (16/40 articles) and FA to 30% (12/40 articles) in 2024, whereas MA declined to 30% (12/40 articles). Manual TKA dominated overall (455/699 articles, 65%), whereas navigation (118 articles, 17%) and PSI (63 articles, 9%) contributed steadily at lower levels. Robotic-assisted surgery emerged after 2021, overall reaching 63/699 articles (9%) and peaking at 26/104 articles (25%) in 2023. Artificial intelligence (AI)-based studies appeared after 2020, reaching 6/112 articles (5%) in 2022, showing steady growth. International collaboration rates were higher in Europe and North America (up to ~58% multiple-country publications [MCP]) than in Asia (<10% MCP). PROMs usage remained broad, with a notable increase in Forgotten Joint Score since 2020. The <i>KSSTA</i> TKA literature (2015-2024) reflects a shift toward personalization (KA/FA) and precision (robotics), alongside the emergence of AI. The convergence of phenotype-aware planning, precise execution and data-driven evaluation outlines a coherent path forward. Continued methodological rigour and standardized reporting are essential to translate these trends into durable improvements in TKA outcomes. Future research should prioritize high-quality comparative studies to clarify the clinical impact of emerging alignment strategies and technological innovations in TKA. Level IV.