Robotic-assisted surgery is now an established part of contemporary orthopaedic practice, particularly in knee arthroplasty, where it has reliably improved the accuracy and reproducibility of implant positioning and bone preparation compared with conventional techniques. Better technical execution, however, has not consistently translated into better patient outcomes or implant survivorship, suggesting that the next decade of development may depend less on additional precision than on addressing clinical needs that remain unmet.

To examine the current strengths and limitations of robotic-assisted orthopaedic surgery and to define, from the surgeon’s perspective, the characteristics of an ideal robotic companion over the next decade across five domains: smarter planning and clinical decision support, simpler workflow and wider accessibility, better intraoperative assessment of soft tissues and biomechanics, greater patient-specific adaptability, and integration into surgical education.

Narrative review of the current literature on robotic-assisted orthopaedic surgery, with particular focus on total knee arthroplasty and on emerging enabling technologies.

Progress in artificial intelligence, imaging analysis, augmented reality, sensor technologies and simulation could extend the robotic role well beyond surgical execution, towards planning, intraoperative decision support, patient-specific adaptation and training. Realising this potential will require solid clinical validation, improved cost-effectiveness, smooth workflow integration, and careful attention to the ethical and medicolegal questions these systems raise.

A robotic companion should never replace surgical judgement; its role is to provide clinically meaningful information that helps surgeons decide better, tailor treatment and improve care. Future systems should be judged on clinical grounds rather than technical sophistication — not by how advanced they are, but by whether they solve the problems surgeons and patients actually face.

V; Expert opinion.