Global Research Trends in Robot-Assisted and 3D Printing Technologies for Total Knee Arthroplasty: An Analysis Based on Bibliometrics and Knowledge Graphs

Global Research Trends in Robot-Assisted and 3D Printing Technologies for Total Knee Arthroplasty: An Analysis Based on Bibliometrics and Knowledge Graphs | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global Research Trends in Robot-Assisted and 3D Printing Technologies for Total Knee Arthroplasty: An Analysis Based on Bibliometrics and Knowledge Graphs Jiakang Peng, Feng Tian, Yu Rao, Chuan Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9086357/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study systematically reviews the research trends in robot-assisted and 3D printing technologies for total knee arthroplasty (TKA) from 2000 to 2025, employing bibliometric and knowledge graph analysis methodologies. By retrieving relevant Chinese and English literature from CNKI and Google Scholar databases, 180 high-quality research papers were selected and included. Information such as publication trends, research entities, thematic hotspots, technology types, and frontier dynamics were extracted and analyzed. Results indicate that research in the TKA field has grown rapidly since 2016, with robot-assisted technology dominating, while 3D printing applications have gradually expanded to preoperative planning, guide plate fabrication, and personalized prostheses. Clustering and keyword co-occurrence analysis revealed research hotspots centered on core issues such as “osteotomy precision,” “postoperative alignment restoration,” and “prosthesis positioning.” Research frontiers are evolving toward intelligent robotic systems, personalized 3D printing, and biocompatible materials. Combining domestic and international case studies, this paper compares the clinical performance of multiple domestic and imported surgical robotic systems, noting the increasing maturity of domestic systems in terms of accuracy, stability, and learning curves. Finally, the study addresses current limitations and future directions, emphasizing the critical value of multimodal fusion and intelligent decision-making systems in precision medicine for TKA. Total knee arthroplasty Robot-assisted 3D printing Bibliometrics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Total knee arthroplasty (TKA), as the standard treatment for end-stage knee osteoarthritis, has seen a continuous increase in surgical volume. Concurrently, patients' demands for postoperative function and long-term stability have risen, gradually revealing the limitations of traditional techniques in prosthesis alignment, individualized precision, and long-term efficacy (Wan et al., 2023 ). To enhance intraoperative consistency and postoperative structural reconstruction, robot-assisted systems and 3D printing technologies have been integrated into the TKA workflow, facilitating precise convergence between preoperative planning and intraoperative execution (Shu et al., 2024 ). Robot systems improve bone cut control through path planning, demonstrating significant advantages in restoring mechanical axes, achieving soft tissue balance, and providing navigation feedback (Kow et al., 2024 ; Alrajeb et al., 2024 ). Domestic systems like “Honghu” exhibit comparable imaging metrics to international counterparts but lag in efficiency and stability (An et al., 2023; Wang et al., 2024). Three-dimensional printing technology, leveraging imaging modeling, enhances preoperative guide design and intraoperative positioning, significantly improving alignment accuracy and operational efficiency, particularly for patients with complex bone deformities (Huang et al., 2021; Peng & Zhang, 2023). Despite widespread adoption of both technologies, clinical research on their synergistic pathways remains limited, with insufficient systematic analysis of indication classification, long-term efficacy, and integration mechanisms (Hu et al., 2025 ). This study employs bibliometric and knowledge graph methodologies to examine research trends, thematic aggregation, and integration pathways in robotics and 3D printing within the TKA field across Chinese and English literature from 2000 to 2025. It aims to clarify core issues, identify emerging hotspots, and provide theoretical support for technological integration and the construction of intelligent surgical systems. Materials and Methods Data Sources and Retrieval Strategy This study selected Google Scholar and China National Knowledge Infrastructure (CNKI) as primary retrieval platforms, setting the time range from 2000 to 2025. Boolean logic combinations were constructed around keywords such as “total knee arthroplasty,” “robot-assisted,” and “3D printing” to enhance retrieval coverage and accuracy. For the English section, a combination of subject terms and free-text words was used. For the Chinese section, matching was restricted to the title and full-text fields to ensure professionalism. During the screening process, only formally published journal articles were retained, while non-core materials such as conference proceedings and patents were excluded. After exporting all literature, field coding and semantic standardization were performed. A complete and standardized dataset was constructed through manual review and script-based cleaning for subsequent analysis. Inclusion and Exclusion Criteria Inclusion Criteria 1. Research content involves robot-assisted technology or 3D printing technology. 2. Study subjects pertain to total knee arthroplasty applications. 3. Publication date falls between 2000 and 2025. 4. Document type is formally published journal articles. 5. Literature is in Chinese or English with complete information. Exclusion Criteria 1. Studies unrelated to total knee arthroplasty. 2. Literature not involving robot-assisted or 3D printing technologies. 3. Non-formal publications such as conference abstracts, brief reports, or news articles. 4. Duplicate publications or literature with highly redundant content. 5. Studies with missing or incomplete metadata. 6. Early studies published before 2000. Literature Screening Process Literature screening was conducted in four sequential phases—“Retrieval and Merging—Deduplication and Cleaning—Criteria Screening—Final Inclusion”—to ensure data quality and thematic focus. Initially, searches in Google Scholar and CNKI yielded 153 and 183 records respectively, resulting in 336 initial records after merging. Deduplication identified 32 duplicate records, resulting in the removal of 22 articles and retention of 314. Further cleaning of the year field excluded 8 articles lacking publication dates, yielding 306 valid records. Thematic screening was then conducted based on inclusion and exclusion criteria. Keyword screening eliminated 123 articles unrelated to robot-assisted surgery, 3D printing, or TKA. One early-period article was removed based on the timeframe (2000–2025), and two studies outside the medical or engineering domains were excluded. The final sample comprised 180 articles, representing 53.57% of the original total. The entire screening process strictly adhered to structured standards, ensuring high relevance and data integrity of the included literature and laying the foundation for subsequent bibliometric analysis. The literature screening flowchart is shown in Fig. 1. Data Extraction and Preprocessing Following the initial screening, this study conducted structured information extraction from 180 literature sources, covering core fields such as title, author, year, journal, and keywords. The data was imported into Excel and uniformly encoded and formatted using Python scripts. Keyword standardization was achieved through Chinese-English mapping and synonym consolidation. Chinese terminology alignment utilized semantic dictionaries for automatic matching, enhancing the accuracy of knowledge graph construction. Data cleaning removed missing fields and format anomalies, while title cleansing algorithms ensured precise deduplication. Ultimately, literature was categorized into three groups—robot-assisted, 3D printing, and hybrid approaches—based on keyword features, providing foundational data for subsequent analysis. Bibliometric and Statistical Analysis Methods Integrating bibliometric and statistical analysis methodologies, the study leverages Python's visualization ecosystem with specialized modules including NetworkX, Matplotlib, Scikit-learn, and SciPy. Analysis unfolds across multiple dimensions: keyword co-occurrence relationships, thematic aggregation structures, and temporal evolution trajectories. During statistical processing, modules like pandas, matplotlib, and numpy were employed for data organization and graphical generation. This enabled analysis of publication volume trends, high-frequency keyword distribution statistics, and quantitative calculations of author and journal contributions. To further dissect structural connections between keywords, a co-occurrence matrix is constructed and K-means clustering is applied to delineate thematic structures. This approach comprehensively considers multidimensional features including node spatial positioning, centrality metrics, keyword frequency, and average year of appearance. Time-window analysis identifies research frontiers, while annual trends in keyword frequency reveal phased shifts in emerging research hotspots and focal points. Knowledge Graph Construction and Visualization Tools Python and the CiteSpace visualization ecosystem were employed to construct knowledge graphs. During graph construction, “keywords” served as nodes to generate co-occurrence graphs, where node size reflected frequency and edge thickness indicated co-occurrence strength. K-means clustering analyzed keywords to generate semantically clear thematic labels, with convex hull algorithms delineating cluster boundaries. For density visualization, Gaussian kernel density estimation generates a heatmap illustrating keyword distribution density. In temporal analysis, a heatmap matrix displays keyword × year frequency distributions. An Overlay view employs color gradients to represent the average year of keyword emergence, visually revealing the temporal evolution of research themes. Results Publication Evolution Trends and Quantitative Characteristics Research on robot-assisted and 3D printing technologies in total knee arthroplasty has shown continuous growth since 2000. As shown in Fig. 2 , the total number of publications increased from 1 in 2000 to 35 in 2025. The period from 2000 to 2014 constituted the nascent stage, characterized by sparse publications. Growth commenced in 2015, accelerated after 2018, and entered a phase of rapid expansion post-2020, with research momentum steadily increasing. By 2025, the cumulative literature volume reached 180 papers, exhibiting exponential growth. From the perspective of technological pathways, robot-assisted research holds an absolute dominant position, with a total of 157 publications accounting for 87.2% of the literature. The 3D printing direction comprises 16 publications, primarily focused on intraoperative guide design and personalized osteotomy. Research integrating “robotics + 3D printing” comprises only 7 publications, representing an emerging interdisciplinary field. The onset years for each research type show marked differences: robot-assisted research began as early as 2000, while 3D printing technology emerged only in 2016, reflecting a significant temporal gap in the maturity and penetration pathways of these two technologies. Categorized by research phase, the period from 2020 to 2025 is defined as the “rapid growth phase,” accounting for 133 publications (73.9% of the total). The remaining phases comprise the development stage (21.7%), exploratory stage (1.7%), and nascent stage (2.8%), further validating the field's entry into a concentrated growth phase. Among highly cited publications, as shown in Table 1 ,the study “Total Knee Arthroplasty Assisted by 3D-Printed Customized Surgical Navigation Templates” from Guizhou Orthopedic Hospital received the highest citation count at 42. Institutions such as the Army Medical University, Nanjing Medical University, and the General Hospital of the People's Liberation Army made significant contributions in this field, with research covering key technical areas including 3D-printed guides, comparisons of domestic robotic systems, and postoperative alignment accuracy. These publications not only demonstrate the depth of domestic research in this domain but also highlight core issues concerning the optimization of TKA surgery through robotics and 3D printing. Table 1 Number of Top 10 Cited Publications Ranking Document Name Number of citations (times) mechanism 1 Total knee replacement assisted by 3D-printed personalized surgical navigation template 42 Guizhou Provincial Orthopedic Hospital 2 A study on the improvement of femoral rotation alignment and early efficacy of robot-assisted total knee arthroplasty. 21 Joint Surgery Center, First Affiliated Hospital of Army Medical University (Southwest Hospital) 3 Application of 3D-printed surgical guides in total knee arthroplasty for patients with varus and valgus deformities 18 Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University; Institute of Digital Medicine, Nanjing Medical University; Jiangsu Provincial Clinical Engineering Research Center for Digital Medicine and 3D Printing 4 A comparative study of the short-term efficacy of domestically produced "Honghu" orthopedic surgical robot-assisted surgery and traditional total knee arthroplasty. 17 Department of Orthopedics, Fourth Medical Center of the PLA General Hospital; National Clinical Research Center for Orthopedics and Sports Rehabilitation; Nankai University School of Medicine 5 Research on Robot-Assisted Total Knee Arthroplasty System and its Preclinical Application 17 Shanghai Jiao Tong University 6 Application of robot-assisted technology in total knee replacement surgery 16 Department of Joint Surgery, Affiliated Hospital of Qingdao University 7 A Review of Clinical Applications of Joint Surgery Robots in 2021 15 PLA Medical College; Department of Orthopedics, Fourth Medical Center of the PLA General Hospital; National Clinical Research Center for Orthopedics and Sports Rehabilitation 8 A review of research on robot-assisted knee replacement surgery systems 12 School of Mechanical and Electrical Engineering and Automation, Shanghai University 9 Changes in surgery time and blood loss during total knee replacement surgery using 3D-printed personalized osteotomy molds 11 Department of Orthopedics, Shenyang Military Region General Hospital 10 Robot-assisted minimally invasive total knee replacement surgery system 10 School of Mechanical Engineering and Automation, Beijing University of Aeronautics and Astronautics In summary, the number of publications in this field is growing rapidly, with research themes clearly focused and a distinct path of technological evolution. Robot-assisted technology serves as the dominant approach, while 3D printing and integrated research demonstrate significant upward potential, indicating vast room for future development. Distribution Structure of Research Entities As shown in Fig. 3 , research on robot-assisted and 3D printing technologies in total knee arthroplasty exhibits a highly concentrated distribution of authors and institutions. Among high-output authors, Zhang leads with 10 publications, significantly ahead of others. Following are units or authors such as “Department of Orthopaedics,” “The Second Hospital of Shanxi Medical University,” “Taiyuan 030001,” and “Shanxi,” with publication counts generally ranging between 6 and 7, indicating stable research output capacity among certain teams in this field. Smith & Nephew also ranks prominently among corporate institutions, reflecting sustained industry interest in this technical pathway. Regarding journal distribution, English core journals account for 72.8% of publications. Among international journals, 131 papers were published in “foreign-language journals,” while the primary Chinese sources were Chinese Journal of Tissue Engineering Research and 《中国组织工程研究》, each hosting 7 papers. Distribution across other journals was relatively dispersed. Authors exhibit close collaboration, with most papers featuring 4–8 authors and some exceeding 10 contributors. This reflects interdisciplinary and cross-institutional collaboration as a common research model in this field, facilitating technological integration and clinical application. Overall, the research landscape exhibits structural characteristics of “concentrated high-output authors, core journal clustering, and active collaborative networks,” indicating significant potential for internationalization, organizational synergy, and disciplinary convergence in this domain. Research Hotspots and Knowledge Base Figure 4 shows the keyword frequency statistics, indicating that the research focus is highly concentrated on total knee arthroplasty and its key technical pathways. “Total knee arthroplasty” and “robotic” appeared 174 and 157 times respectively, forming the most central term combination in the current field. This reflects that technical research predominantly revolves around the clinical scenario of TKA, with robotic assistance serving as the primary technological support. Among high-frequency keywords, terms like “unicompartmental arthroplasty,” “clinical research,” “alignment,” and “accuracy” appear frequently, indicating that research content has gradually extended from technology introduction to surgical precision control and clinical efficacy validation. In terms of keyword composition, “total knee arthroplasty” and ‘robotic’ collectively accounted for over 70% of mentions, indicating a highly concentrated research focus. In contrast, keywords like “3D printing,” “surgical guides,” “navigation,” and “personalization” appeared less frequently but carried distinct technological attributes, primarily associated with preoperative planning and the development of individualized treatment strategies. Concurrently, Fig. 5 also illustrates,the activity levels of terms such as “meta-analysis,” “therapeutic efficacy,” “prosthesis,” and “osteoarthritis” are also increasing, indicating a gradual shift in research focus toward long-term clinical evaluation and evidence-based support. The structural distribution of the keyword co-occurrence network further reveals intrinsic connections among terms. “Total knee arthroplasty,” “robotic,” “alignment,” and ‘accuracy’ form the core region of the network, exhibiting strong connectivity and thematic dominance. While “3D printing,” “surgical guides,” and “navigation” are positioned at the network periphery, they maintain stable co-occurrence with core nodes, reflecting their auxiliary roles within the research framework. Density distribution analysis indicates that research hotspots primarily cluster in the high-density zone formed by “robotic-assisted total knee arthroplasty.” Secondary clusters include themes like “3D printing,” “meta-analysis,” and “unicompartmental knee arthroplasty,” revealing a distinct hierarchical structure in the hotspot distribution. The temporal evolution path reveals that early research focused on procedural fundamentals like “total knee arthroplasty,” “alignment,” and “prosthesis.” In recent years, keywords have progressively shifted toward “accuracy,” “personalization,” “efficacy,” and “meta-analysis,” indicating a growing emphasis on clinical outcomes and precision control. Notably, “3D printing” and “surgical guides” emerged relatively recently, reflecting their status as emerging technological growth areas. Clustering results validate these analyses, grouping keywords into four primary thematic clusters: technology-driven topics centered on “total knee arthroplasty—robotics”; procedure optimization categories exemplified by “clinical research—alignment—3D printing”; Evidence-based evaluation focused on “unicompartmental arthroplasty—meta-analysis—outcomes”; and foundational clinical issues encompassing “accuracy—prosthesis—osteoarthritis.” Together, these form a relatively robust knowledge framework for the field. In summary, robot-assisted technology is the core driver of this research field. Research focus is concentrated on intraoperative precision control and clinical efficacy evaluation. Emerging technologies such as 3D printing are gradually being integrated into the existing system, demonstrating positive potential in promoting deeper research. Research Frontier Dynamics and Technology Comparison The distribution of technology types extracted from existing literature shows that "robot-assisted" technology dominates the research system, accounting for 87.2% (157 articles); "3D printing" related studies number 16 (8.9%); and while "robot + 3D printing" integration studies only account for 3.9% (7 articles), they have already shown high development potential. Observing the time series, "robot-assisted" technology has grown rapidly since 2017, gradually forming the main research line, while "3D printing" and its integration paths, although starting later, are gradually attracting attention and have certain room for expansion. The relevant results are shown in Fig. 6 . Focusing on the keyword distribution over the past three years((Figs. 7 and 8 ), we can see that "total knee replacement," "robot," and "clinical research" have consistently appeared frequently, reflecting that precise operation, intelligent intervention, and clinical evidence remain the core directions of current research. Meanwhile, Table 2 presents a comparison between robot-assisted and 3D-printed guide-assisted TKA procedures,in June 2025, the world's first revision surgery using a domestically produced robot-assisted knee replacement, performed by the team led by Tian Hua at Peking University Third Hospital, combined with a personalized 3D-printed prosthesis system, was carried out on a complex revision procedure for a 73-year-old female patient. This case not only achieved the synergy between preoperative 3D modeling and intraoperative trajectory adjustment but also effectively solved technical bottlenecks such as inaccurate positioning, severe bone defects, and poor prosthesis stability during revision surgery, representing a cutting-edge breakthrough in the integrated application of robots and 3D printing. Comparative analysis shows that this case demonstrates significant advantages in multiple dimensions. The solution adopted by Tian Hua's team integrates robotics, personalized prostheses, and complex revision surgery, possessing highly autonomous and adjustable characteristics. In contrast, Huang Chenyu's team in 2021 used a 3D-printed guide plate only for preoperative positioning simulation in primary replacement surgery, while Wang Hongping's team's research in 2024 focused on comparing the two types of robotic systems, lacking personalized component design and not addressing intraoperative intelligent response or path control. In terms of surgical complexity, precision, and postoperative outcomes, Tian Hua's team's solution demonstrated superior performance in force line restoration, visual control, and operational efficiency. This achievement marks the first application of a domestically produced robotic system in knee revision surgery, showcasing high technological integration, independent intellectual property rights, and demonstrating the synergistic ability to achieve soft tissue balance, force line control, and prosthesis stability in complex scenarios. It also sets an important technological benchmark internationally. Table 2 Comparison of Robot-Assisted and 3D Printed Guide Plate-Assisted TKA Procedures project Robot-assisted TKA (Wang Hongping et al., 2024 ) 3D printed guide plate TKA (Huang Chenyu et al., 2021 ) Sample size BRATKA group: 40 cases / HRATKA group: 53 cases Printing group: 20 cases / Control group: 19 cases Surgery time (minutes) HRATKA group: 94.1 ± 10.8 Print count: 62.4 ± 16.1 Cut length (cm) HRATKA group: 14.8 ± 2.1 No clear report Intraoperative blood loss (mL) Not reported The printing group showed a significantly lower rate than the control group (P < 0.05). Incidence of complications There were no significant differences. No serious complications were observed in the printing group. Postoperative alignment (HKAA angle) Significantly superior to the traditional group (P < 0.05) The printing group alignment angle is better (P < 0.05). Postoperative KSS score (3 months) Significant improvement (P < 0.05) The printing group showed a higher rate than the control group (P < 0.05). VAS score (postoperative pain) The HRATKA group was significantly lower than the BRATKA group. The printing group had lower pain scores one week post-surgery. Technical stability and controllability Higher, especially excelling in complex surgeries. Preoperative simulation enhances predictability and facilitates intraoperative control. Personalized matching capabilities High efficiency; the robotic system allows for intraoperative adjustments to the surgical plan. Relying on preoperative printing limits intraoperative flexibility. Based on current development trends, robot-assisted technology will maintain its mainstream position, with its capabilities in intraoperative precision control, path planning, and multidimensional feedback constituting key advantages. The value of 3D printing in personalized prosthesis design is gradually emerging, especially in complex cases and revision surgeries, demonstrating unique adaptability. In the future, the deep integration of these two technologies is expected to construct a new paradigm of intelligent surgery that is visible, controllable, and quantifiable, becoming a core standard for evaluating next-generation surgical techniques. Discussion Key Findings Based on a quantitative and visual analysis of 180 articles published between 2000 and 2025, this paper systematically reviews the research trends and knowledge structure of robot-assisted and 3D printing technologies in total knee arthroplasty. The results show that this field has entered a period of rapid development since 2017, with the number of publications reaching its peak in 2025. The main research focus is on Chinese and some international orthopedic centers, with most articles concentrated in core foreign journals, demonstrating a clear international character. Keywords focus on terms such as "total knee replacement," "robotics," "3D printing," and "personalization," with research centered on precise intraoperative control and postoperative force line restoration. Robot-assisted technology accounts for 87.2%, maintaining its absolute dominance; 3D printing is gradually being embedded in preoperative planning and individualized design, and its integration pathway is being explored. The robotic + 3D printing revision surgery practice conducted by Peking University Third Hospital in 2025 marks the entry of the synergistic application of these technologies into the clinical validation stage. The overall trend points to the development path of "precise alignment – ​​biomechanical matching – intelligent assisted surgery," providing direction for future research and technology implementation. Publication Trend Evolution From 2000 to 2025, research on robot-assisted and 3D printing technologies in the TKA field has shown a phased growth trend. In the early stages, it was in the theoretical exploration and pilot phase, with the average annual number of publications remaining in single digits from 2000 to 2014, showing slow growth. After 2015, the field entered an expansion phase, with the number of publications steadily increasing to 14 in 2019. Research gradually formed a systematic framework and accelerated its practical application driven by clinical trials in China, the US, and the UK. The period from 2020 to 2025 represents a rapid development phase, with publications during this period accounting for over 80% of the total, reaching 35 in 2025. The cumulative total increases from 69 in 2020 to 180, indicating a maturing research ecosystem and the technology moving towards clinical standardization. Robot-assisted research saw the most significant growth, accounting for 87.2% and maintaining a dominant position. 3D printing literature started later, accumulating only after 2016. While fusion technologies emerged in 2015, only 7 articles have been published, indicating an initial transitional stage, although their application potential has already been demonstrated in some cases. The phase-by-phase statistics show that the rapid growth period accounts for 73.9%, exhibiting a typical concentrated explosive growth characteristic, with research driven by a high degree of dependence on technological development and clinical feedback. Overall, research themes have shifted from macro-level frameworks to intraoperative precision, cost control, and long-term effects, demonstrating a high degree of consistency between technological evolution and research enthusiasm. Hot Topics and Knowledge Base A keyword co-occurrence analysis based on 180 articles shows that research in the TKA field is highly concentrated. "Total knee replacement" (174 times) and "robot" (157 times) are the most frequent keywords, forming the core issue framework of the field. Keywords such as "3D printing," "personalized," "alignment," "accuracy," and "meta-analysis" collectively form a knowledge structure centered on technological implementation, intraoperative control, and clinical assessment. The co-occurrence network shows a strong association between "robot" and terms such as "alignment" and "prosthesis," reflecting its crucial role in intraoperative precision control; "3D printing" is more associated with "guide plate" and "revision," demonstrating its adaptability in personalized procedures and complex cases. The temporal evolution trend indicates that "robot" has been gaining popularity since 2015, while "3D printing" and "personalized" have grown rapidly in recent years, reflecting a positive trend in research towards integrating technology with clinical evidence. Cluster analysis identified four main themes covering surgical innovation, efficacy evaluation, preoperative planning, and revision surgery, indicating that this field is entering an integrated development stage centered on high precision, individualization, and systematic evaluation. Comparison of Technological Advancements Currently, in total knee arthroplasty, robot-assisted and 3D-printed surgical guides demonstrate their respective significant advantages and application differences. Robot-assisted technology, with its real-time feedback capabilities in intraoperative navigation, precise osteotomy, and force line adjustment, has achieved good results in improving prosthesis placement accuracy and postoperative lower limb force line recovery. For example, a comparison between the domestic HURWA and imported Brainlab Knee3 systems by Wang Hongping et al. showed that both have significant advantages in imaging indicators, but no significant difference has yet been observed in postoperative functional improvement. In contrast, 3D-printed surgical guides, with their core focus on preoperative personalized design, can effectively optimize osteotomy plans and shorten surgical time in patients with complex deformities. As shown in the study by Huang Chenyu et al., the 3D-printed group outperformed the traditional group in terms of intraoperative blood loss, postoperative VAS score, and KSS score. Compared to the technologies mentioned above, the "robot + 3D printed prosthesis" combined approach reported by Tian Hua's team in 2025 achieved a breakthrough in the integrated process from preoperative modeling to intraoperative navigation in complex revision surgery scenarios. This significantly improved the adaptability and mechanical alignment accuracy of bone defect repair, marking a shift in the field from a single technology to a multi-faceted integrated development. Limitations and Prospects This study reviewed the research hotspots, technological trends, and cutting-edge developments of robot-assisted and 3D printing technologies in total knee arthroplasty. However, certain limitations remain in the research design and data sources. The literature scope was limited to Chinese and English databases on Google Scholar and CNKI platforms from 2000 to 2025, which may have omitted some conference papers, grey literature, and important unpublished results, potentially affecting the comprehensiveness of the conclusions. In the keyword extraction and cluster analysis process, inconsistencies in sample labeling and missing information may affect the accuracy of the co-occurrence network and the stability of the cluster structure. While the technical pathway analysis has constructed a relatively clear knowledge structure, it has not yet explored in depth key clinical factors such as implementation costs, learning curves, and individual patient differences, limiting the applicability of the results in practical application. Future research should incorporate multi-center real-world data to systematically validate efficacy differences from multiple dimensions, including pathological type, technological generation, and surgeon experience. Simultaneously, it should accelerate the development of standards and evaluation systems to promote the rapid evolution of TKA intelligent technology from an auxiliary tool to a standardized procedure, enabling the sustainable clinical implementation of precision orthopedics.。 Conclusion This study, based on 180 Chinese and English articles published between 2000 and 2025, systematically presents the research evolution trends, technical pathways, and thematic focuses of robot-assisted and 3D printing technologies in total knee arthroplasty (TKA) through bibliometric analysis and knowledge graph construction. Results show that robotics has accelerated its development since 2015, gradually becoming the dominant means of achieving standardization and precision in TKA, accounting for the absolute majority of the literature. 3D printing, on the other hand, is mainly applied to preoperative planning, guide plate customization, and deformity correction, demonstrating significant advantages in specific clinical scenarios. In 2025, the integration of these two technologies will be applied for the first time in knee revision surgery, marking the entry of this field into a composite integration stage. Keyword co-occurrence and clustering results reflect that the research focus is shifting from intraoperative control to preoperative modeling and postoperative force line reconstruction. Core terms such as "alignment," "guide plate," and "personalization" construct the evaluation framework. The number of Chinese researchers continues to grow, with a number of domestic teams gradually establishing influence on international platforms, and domestic research pathways becoming increasingly mature. Currently, there are still problems such as insufficient standardized assessment, limited data accumulation, and insufficient depth of technical collaboration. It is necessary to strengthen the integrated mechanism research of preoperative, intraoperative, and postoperative procedures, improve the multi-center empirical basis, and construct an intelligent TKA surgical system guided by precise alignment, functional recovery, and long-term stability. Review Overview of Total Knee Arthroplasty Research As the standard treatment for end-stage knee osteoarthritis (KOA), TKA has a clear effect on relieving pain, restoring knee joint function, and improving quality of life, and has become a widely performed routine surgery in orthopedic clinics worldwide. Since my country entered a period of accelerated aging, the annual number of this procedure has continued to climb. According to a report published by Zhang Siwei on June 19, 2025, more than 480,000 related surgeries were performed in 2020, nearly nine times the number in 2011. The demand for revision surgeries also increased simultaneously, exceeding 50,000 cases that year, accounting for about 10%, reflecting the simultaneous increase in technical complexity and clinical pressure. Surgical robots, as an emerging technological approach, are gradually changing the implementation mode of TKA. Research evidence shows that these systems demonstrate significant advantages in improving surgical precision, stabilizing prosthesis alignment, and enhancing patient satisfaction (Hu Jialiang et al., 2025). Domestically produced systems such as "Honghu," "Hehua," and "HURWA" have been clinically deployed, forming a diversified technological landscape alongside international brands like Mako and ROSA. "Honghu" shows stable performance in postoperative HKA angle, joint range of motion, and complication control (An Haoming et al., 2023); "Hehua" achieves navigation accuracy within 95% of 1 mm, with outstanding operational consistency (Heng Chunning et al., 2025); HURWA and Brainlab Knee3 each have advantages in postoperative force line recovery, with essentially the same short-term efficacy (Wang Hongping et al., 2024 ). The ROSA system has attracted attention due to its clear control over HKA angle and ROM, with intraoperative osteotomy errors mostly controlled within 2 mm and a relatively short learning cycle (Wang Fan, 2023). The Mako surgical procedure combines the advantages of trauma control and rapid recovery, allowing patients to walk within 24 hours post-surgery with minimal nursing intervention (Sun Ying and Lu Jike, 2025). From a developmental perspective, robot-assisted total knee arthroplasty (TKA) has moved from the experimental stage to widespread application, becoming a crucial engine for promoting precision and minimally invasive orthopedic surgery. In challenging scenarios such as complex deformities, revision surgeries, and personalized reconstructions, the value of this technology continues to expand, with significant future potential in areas such as intraoperative navigation fusion, multimodal imaging support, and integrated workflow optimization. Research Progress in Robot-Assisted Total Knee Arthroplasty The application of intelligent medical technology in clinical orthopedics continues to deepen. Robot-assisted surgery and 3D printing are widely used in total knee arthroplasty, demonstrating significant advantages in intraoperative precision control and operational stability, and are gradually driving the transformation of traditional surgical procedures towards precision. Related studies indicate that 3D-printed surgical guides are clinically superior to traditional techniques in knee deformity correction, showing better performance in terms of intraoperative blood loss, postoperative drainage, and operation time. Early KSS scores and pain relief indices also show significant improvements (Huang et al., 2021). Furthermore, prospective studies have confirmed that 3D-printed assisted total knee arthroplasty (TKA) has comprehensive advantages in intraoperative efficiency, perioperative risk control, and functional recovery, reducing intraoperative blood loss, shortening operation time, lowering the incidence of complications, and achieving better AKS, Lysholm, and IKDC scores than the traditional group (Peng and Zhang, 2023). In the field of medical education, there have been explorations combining robot design with 3D-printed models for TKA simulation training. Related research shows that this model helps improve learners' mastery of surgical procedures and understanding of key technical operations, alleviating the problem of insufficient practical experience and effectively shortening the learning cycle (Huang et al., 2022). Based on current progress, the application of robot-assisted total knee arthroplasty (TKA) and 3D-printed surgical guides has expanded from intraoperative precision control to multiple levels, including preoperative planning and teaching practice. Future research should focus on long-term efficacy assessment, clinical adaptability validation in complex cases, and the potential for deep integration in highly complex surgical procedures, promoting the evolution of multi-technology collaboration towards standardized clinical pathways. Application Research of 3D Printing Technology in Total Knee Arthroplasty With the deepening of personalized medicine concepts, the application of 3D printing technology in total knee arthroplasty is constantly expanding, gradually becoming an important research direction in this field. It demonstrates high adaptability in preoperative assessment, guide customization, and precision control of intraoperative osteotomy and prosthesis implantation. Related studies have shown that 3D-printed navigation templates significantly improve the accuracy of lower limb alignment correction, while also reducing surgical time, intraoperative bleeding, and postoperative drainage, thus helping to accelerate perioperative recovery (Huang et al., 2021). In terms of postoperative functional recovery, this technology has also shown good results, manifested in increased knee joint range of motion, improved functional scores, and reduced complication rates, gradually demonstrating its clinical value (Peng Liangzhen and Zhang Fenghai, 2023). Beyond treatment, 3D printing is being widely introduced into auxiliary processes such as teaching training and preoperative simulation. Existing research has explored the combined application of robotic surgical design with 3D-printed simulation models in TKA simulation teaching, which not only improves operators' understanding of complex surgical structures but also alleviates the problem of insufficient clinical practice opportunities to some extent (Huang Ying et al., 2022). Retrospective studies by international teams have further validated the effectiveness of this technology in preoperative planning. Capece analyzed intraoperative data from 300 patients with mild knee deformities, showing that a robotic preoperative planning system combined with 3D printing could accurately predict prosthesis size and alignment parameters, achieving excellent intraoperative matching results, and simultaneously improving operational stability and postoperative alignment accuracy (Capece et al., 2024 ). The application of 3D printing technology in total knee arthroplasty (TKA) has expanded from a single intraoperative aid to diversified end-to-end surgical management. Its role in improving precision treatment, perfecting the teaching system, and supporting decision-making is gradually deepening, and its future development potential deserves continued attention. Comprehensive Application of Precision Orthopedic Techniques The introduction of high-precision technologies has driven the transformation of orthopedic diagnosis and treatment processes towards individualization, visualization, and intelligence, which is particularly evident in total knee arthroplasty. Current clinical practice places greater emphasis on the accuracy of preoperative planning, the precision of intraoperative procedures, and the predictability of postoperative functional recovery. Robot-assisted surgical systems and imaging simulation technology have become important means to improve surgical quality. A study by Hu Jialiang et al., based on 55 patients, found that ROSA robot-assisted TKA was superior to traditional methods in terms of prosthesis implantation precision, lower limb alignment, and early postoperative ROM (Hu Jialiang et al., 2025). Wang Fan further confirmed from the perspectives of randomized controlled trials and learning curves that the system was highly consistent with the preoperative plan in terms of osteotomy precision and operational stability, with errors mostly controlled within 2mm or 3°, and a stable level could be achieved in about 10 surgeries, demonstrating a low learning cost (Wang Fan, 2023). Overall, robotic systems represented by ROSA have achieved collaborative management of multiple stages—preoperative, intraoperative, and postoperative—reflecting the trend of orthopedic surgery towards refinement and intelligence. Bibliometrics and Knowledge Graph Related Research The deep integration of precision orthopedic technology in clinical scenarios has promoted the systematic development of research on the application of robots and 3D printing, with related fields gradually entering a stage of structural organization and dynamic mining. Bibliometrics and knowledge graph analysis, while identifying research growth trends, geographical distribution patterns, and author collaboration networks, also demonstrate outstanding value in revealing terminology clusters, thematic structures, and frontier shifts. In joint replacement research, analysis based on Scopus data indicates that the United States and the United Kingdom are high-incidence areas for research, with total knee arthroplasty constituting the dominant surgical procedure. Research focuses on precise implantation and personalized prosthesis positioning (Kow et al., 2024 ). The continuous iteration of robotic systems, such as ROBODOC, Mako, and Da Vinci, is driving the transformation of surgical techniques from traditional approaches to high-precision and intelligent collaborative systems. Despite cost and regulatory constraints, the overall development momentum remains strong (Hu et al., 2025 ). In spinal surgery, frequently occurring keywords focus on "navigation," "precision," and "screw placement." Meanwhile, "artificial intelligence integration" and "feasibility" are terms appearing more frequently in mutation analysis, reflecting a gradual shift in technological focus from passive navigation to intelligent operating systems (Huang et al., 2026 ). Clustering and topic mining of 2312 relevant articles on the expanded application of 3D printing in bone tumors revealed its strong cross-disciplinary integration potential in preoperative modeling, postoperative reconstruction, radiotherapy adjuvant therapy, and drug resistance mechanism simulation, providing methodological support for personalized treatment (Yu et al., 2025 ). A network meta-analysis of seven hip replacement robotic systems showed positive effects in postoperative length difference control, intraoperative bleeding, and infection rates. Performance differences between systems also provided quantitative evidence for subsequent technology selection and parameter evaluation (Wu et al., 2024 ). At the Chinese research level, relevant reviews indicate that although research on robotic technology in unicompartmental, patellofemoral, and total knee surgeries is increasingly active, there is currently a lack of maturity assessment and systematic quantitative analysis. Bibliometric methods need to be introduced to improve the research framework and promote structural analysis (Qiao Hua and Li Huiwu, 2023). Overall, research on the application of robotics and 3D printing technologies in orthopedic surgery has entered a stage of systematic integration. Bibliometrics, as an important tool for research evolution identification and strategic planning, is playing an increasingly crucial role in multi-database fusion, interdisciplinary collaboration, and visual representation.。 Ethics declaration Not applicable Declarations Ethics declaration Not applicable Funding 1.Beijing Natural Science Foundation – Changping Joint Fund, Grant No. 25L40160 2.Major Science and Technology Special Program of Yunnan Province (Biomedical Special Project), Grant No. 202502AA310005 3.Joint General Program of China-Japan Friendship Hospital and Beijing University of Chemical Technology, Grant No. 2025-NHLHCRF-YXHZ-MS-04 4.National Key Research and Development Program of China, Grant No. 2023YFC2507601 References Heng Chun-ning et al. Li Ke-xin, Luo Han-wen,. Early clinical study of total knee arthroplasty assisted by domestic joint surgery robot[J]. Chinese Journal of Rehabilitation Medicine, 2025, 34(12):90–96. 10.13517/j.cnki.ccm.2025.12.021 Hu Jia-liang, Ma Rui-xiang, Abbas Maimaiti Abula, et al. Comparative study on the short-term efficacy of ROSA orthopedic surgical robot-assisted and traditional total knee arthroplasty[J]. Chinese Journal of Orthopedics and Traumatology, 2025, 38(10):1009–1018. Ying S. Lu Ji-ke. Cooperation of Mako orthopedic surgical robot-assisted total knee arthroplasty[J]. J Robotic Surg (Chinese English). 2025;6(02):235–8. Wang Hongping W, Mingyou T, Zhuodong, et al. Retrospective study of two different surgical robots-assisted total knee arthroplasty[J]. Chin J Orthop Traumatol. 2024;37(09):870–7. Wang F. Randomized controlled trial and learning curve analysis comparing robot-assisted and traditional knee arthroplasty[D]. Shandong Univ. 2023. 10.27272/d.cnki.gshdu.2023.006520 . An Haoming P, Hangyu L. Comparative study of short-term efficacy of domestic Honghu orthopedic surgical robot-assisted and traditional total knee arthroplasty[J]. Chin J Reparative Reconstr Surg. 2023;37(04):404–9. Qiao Hua L. Huiwu. Current status and research progress of knee arthroplasty surgical robots[J]. Journal of Shandong University (Medical Edition), 2023, 61(03):29–36. [8] Peng Liangzhen, Zhang Fenghai. Analysis of the impact of 3D printing technology on perioperative clinical indicators and prognosis of patients undergoing total knee arthroplasty [J]. Chinese Journal of Medical Engineering, 2023, 31(09):63–67. 10.19338/j.issn.1672-2019.2023.09.012 Huang Ying L, Wenhao F. Application of robot-assisted total knee arthroplasty design combined with 3D printed high-fidelity teaching model in postgraduate teaching [J]. Basic Med Clin Pract. 2022;42(06):988–93. 10.16352/j.issn.1001-6325.2022.06.014 . Huang Chenyu T, Cheng W, Bo, et al. Application of 3D printed surgical guide in total knee arthroplasty in patients with varus and valgus deformities[J]. Chin J Tissue Eng Res. 2021;25(18):2789–93. Wan D, Wang R, Wei J, et al. Mapping knowledge landscapes and emerging trends of robotic-assisted knee arthroplasty: a bibliometric analysis[J]. Medicine. 2023;102(38):e35076. Huang H, Lian Z, Liu Y, et al. Global research trends in robot-assisted spinal surgery: a visualized bibliometric analysis[J]. J Robotic Surg. 2026;20(1):1–17. Kow RY, Rani RA, Nazarallah MHM et al. Robotic-assisted hip and knee arthroplasty: a bibliometric analysis using the scopus database[J]. Cureus, 2024, 16(3). Shu B, Ou X, Shi S, et al. From past to digital time: bibliometric perspective of worldwide research productivity on robotic and computer-assisted arthroplasty[J]. Digit Health. 2024;10:20552076241288736. Zhang H, Jiang X, Jin B, et al. Current developments in robotic assistance technology for total knee arthroplasty: a comprehensive overview[J]. J Orthop Surg Res. 2025;20(1):80. Fan X, Wang Y, Zhang S, et al. Orthopedic surgical robotic systems in knee arthroplasty: A comprehensive review[J]. Front Bioeng Biotechnol. 2025;13:1523631. Alrajeb R, Zarti M, Shuia Z, et al. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials[J]. Eur J Orthop Surg Traumatol. 2024;34(3):1333–43. Hu R, Longo UG, Pittman J, et al. Robotic Innovations in Orthopedics: A Growing Landscape, Challenges, and Implications for Care[J]. Osteology. 2025;5(2):13. Capece G, Andriollo L, Sangaletti R, et al. Advancements and strategies in robotic planning for knee arthroplasty in patients with minor deformities[J]. Life. 2024;14(12):1528. Wu Z, Zheng Y, Zhang X. Safety and efficacy of orthopedic robots in total hip arthroplasty: a network meta-analysis and systematic review[J]. J Orthop Surg Res. 2024;19(1):846. Yu HB, Han BJ, Hu JQ et al. Worldwide research on 3D printing for cancer: a dual-method analysis of bibliometrics and stratified focused thematic[J]. Int J Surg, 2025: 101097. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9086357","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":612214496,"identity":"809f20d3-092e-4774-b022-173322be9d34","order_by":0,"name":"Jiakang Peng","email":"","orcid":"","institution":"Dali University","correspondingAuthor":false,"prefix":"","firstName":"Jiakang","middleName":"","lastName":"Peng","suffix":""},{"id":612214497,"identity":"92edea90-88ba-4727-92c5-a0a957c67804","order_by":1,"name":"Feng Tian","email":"","orcid":"","institution":"Kunming Medical 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17:07:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87570,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual Publication Trends and Technological Evolution Chart\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/b3896f13c7a50db4d8c2b2d0.png"},{"id":105499154,"identity":"435e9ec1-073b-41ec-b5de-f6efa730e05a","added_by":"auto","created_at":"2026-03-26 17:07:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":60839,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution Structure of Research Entities\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/d414ec1573f4310b8461e45b.png"},{"id":105499150,"identity":"07fa928e-7c45-4bf7-a5f2-40e926860e15","added_by":"auto","created_at":"2026-03-26 17:07:18","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":62090,"visible":true,"origin":"","legend":"\u003cp\u003eKey Topics and Knowledge Base\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/65903e159b078562de0cba6b.png"},{"id":105499153,"identity":"5dd0b76b-cf46-459a-a78c-490ea8c7a701","added_by":"auto","created_at":"2026-03-26 17:07:18","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":777447,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword Co-occurrence Network\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/2bf27f96afbc6149ad52440c.png"},{"id":105499155,"identity":"d33d40d1-13f7-4088-8689-d4e6f750c46d","added_by":"auto","created_at":"2026-03-26 17:07:18","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":84842,"visible":true,"origin":"","legend":"\u003cp\u003eResearch Frontier Dynamics and Technology Comparison\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/292957047ef8a7cd38fd570a.png"},{"id":105499156,"identity":"7e578cff-e1ae-4b45-a1fa-c822190cd66c","added_by":"auto","created_at":"2026-03-26 17:07:18","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":154821,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword temporal evolution\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/f94c198e69a30dd2238f0843.png"},{"id":105499157,"identity":"c6ba2ff0-75a0-4080-8625-9d2ec7c83063","added_by":"auto","created_at":"2026-03-26 17:07:19","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":458646,"visible":true,"origin":"","legend":"\u003cp\u003eComprehensive Analysis of Keyword Co-occurrence Network\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/b84f06361ced511c19d6c237.png"},{"id":108183054,"identity":"71fcb96a-f935-4372-a1af-f88f91290de4","added_by":"auto","created_at":"2026-04-30 08:59:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1659263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9086357/v1/51798521-02d2-423c-b46d-dee7edc2307e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global Research Trends in Robot-Assisted and 3D Printing Technologies for Total Knee Arthroplasty: An Analysis Based on Bibliometrics and Knowledge Graphs","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTotal knee arthroplasty (TKA), as the standard treatment for end-stage knee osteoarthritis, has seen a continuous increase in surgical volume. Concurrently, patients' demands for postoperative function and long-term stability have risen, gradually revealing the limitations of traditional techniques in prosthesis alignment, individualized precision, and long-term efficacy (Wan et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). To enhance intraoperative consistency and postoperative structural reconstruction, robot-assisted systems and 3D printing technologies have been integrated into the TKA workflow, facilitating precise convergence between preoperative planning and intraoperative execution (Shu et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Robot systems improve bone cut control through path planning, demonstrating significant advantages in restoring mechanical axes, achieving soft tissue balance, and providing navigation feedback (Kow et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Alrajeb et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Domestic systems like \u0026ldquo;Honghu\u0026rdquo; exhibit comparable imaging metrics to international counterparts but lag in efficiency and stability (An et al., 2023; Wang et al., 2024). Three-dimensional printing technology, leveraging imaging modeling, enhances preoperative guide design and intraoperative positioning, significantly improving alignment accuracy and operational efficiency, particularly for patients with complex bone deformities (Huang et al., 2021; Peng \u0026amp; Zhang, 2023). Despite widespread adoption of both technologies, clinical research on their synergistic pathways remains limited, with insufficient systematic analysis of indication classification, long-term efficacy, and integration mechanisms (Hu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This study employs bibliometric and knowledge graph methodologies to examine research trends, thematic aggregation, and integration pathways in robotics and 3D printing within the TKA field across Chinese and English literature from 2000 to 2025. It aims to clarify core issues, identify emerging hotspots, and provide theoretical support for technological integration and the construction of intelligent surgical systems.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eData Sources and Retrieval Strategy\u003c/h2\u003e\n \u003cp\u003eThis study selected Google Scholar and China National Knowledge Infrastructure (CNKI) as primary retrieval platforms, setting the time range from 2000 to 2025. Boolean logic combinations were constructed around keywords such as “total knee arthroplasty,” “robot-assisted,” and “3D printing” to enhance retrieval coverage and accuracy. For the English section, a combination of subject terms and free-text words was used. For the Chinese section, matching was restricted to the title and full-text fields to ensure professionalism. During the screening process, only formally published journal articles were retained, while non-core materials such as conference proceedings and patents were excluded. After exporting all literature, field coding and semantic standardization were performed. A complete and standardized dataset was constructed through manual review and script-based cleaning for subsequent analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Research content involves robot-assisted technology or 3D printing technology.\u003cbr\u003e2. Study subjects pertain to total knee arthroplasty applications.\u003cbr\u003e3. Publication date falls between 2000 and 2025.\u003cbr\u003e4. Document type is formally published journal articles.\u003cbr\u003e5. Literature is in Chinese or English with complete information.\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Studies unrelated to total knee arthroplasty.\u003cbr\u003e2. Literature not involving robot-assisted or 3D printing technologies.\u003cbr\u003e3. Non-formal publications such as conference abstracts, brief reports, or news articles.\u003cbr\u003e4. Duplicate publications or literature with highly redundant content.\u003cbr\u003e5. Studies with missing or incomplete metadata.\u003cbr\u003e6. Early studies published before 2000.\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eLiterature Screening Process\u003c/p\u003e\n\u003cp\u003eLiterature screening was conducted in four sequential phases—“Retrieval and Merging—Deduplication and Cleaning—Criteria Screening—Final Inclusion”—to ensure data quality and thematic focus. Initially, searches in Google Scholar and CNKI yielded 153 and 183 records respectively, resulting in 336 initial records after merging. Deduplication identified 32 duplicate records, resulting in the removal of 22 articles and retention of 314. Further cleaning of the year field excluded 8 articles lacking publication dates, yielding 306 valid records. Thematic screening was then conducted based on inclusion and exclusion criteria. Keyword screening eliminated 123 articles unrelated to robot-assisted surgery, 3D printing, or TKA. One early-period article was removed based on the timeframe (2000–2025), and two studies outside the medical or engineering domains were excluded. The final sample comprised 180 articles, representing 53.57% of the original total. The entire screening process strictly adhered to structured standards, ensuring high relevance and data integrity of the included literature and laying the foundation for subsequent bibliometric analysis. The literature screening flowchart is shown in Fig. 1.\u003c/p\u003e\n\u003cp\u003eData Extraction and Preprocessing\u003c/p\u003e\n\u003cp\u003eFollowing the initial screening, this study conducted structured information extraction from 180 literature sources, covering core fields such as title, author, year, journal, and keywords. The data was imported into Excel and uniformly encoded and formatted using Python scripts. Keyword standardization was achieved through Chinese-English mapping and synonym consolidation. Chinese terminology alignment utilized semantic dictionaries for automatic matching, enhancing the accuracy of knowledge graph construction. Data cleaning removed missing fields and format anomalies, while title cleansing algorithms ensured precise deduplication. Ultimately, literature was categorized into three groups—robot-assisted, 3D printing, and hybrid approaches—based on keyword features, providing foundational data for subsequent analysis.\u003c/p\u003e\n\u003ch3\u003eBibliometric and Statistical Analysis Methods\u003c/h3\u003e\n\u003cp\u003eIntegrating bibliometric and statistical analysis methodologies, the study leverages Python's visualization ecosystem with specialized modules including NetworkX, Matplotlib, Scikit-learn, and SciPy. Analysis unfolds across multiple dimensions: keyword co-occurrence relationships, thematic aggregation structures, and temporal evolution trajectories. During statistical processing, modules like pandas, matplotlib, and numpy were employed for data organization and graphical generation. This enabled analysis of publication volume trends, high-frequency keyword distribution statistics, and quantitative calculations of author and journal contributions. To further dissect structural connections between keywords, a co-occurrence matrix is constructed and K-means clustering is applied to delineate thematic structures. This approach comprehensively considers multidimensional features including node spatial positioning, centrality metrics, keyword frequency, and average year of appearance. Time-window analysis identifies research frontiers, while annual trends in keyword frequency reveal phased shifts in emerging research hotspots and focal points.\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eKnowledge Graph Construction and Visualization Tools\u003c/h2\u003e\n \u003cp\u003ePython and the CiteSpace visualization ecosystem were employed to construct knowledge graphs. During graph construction, “keywords” served as nodes to generate co-occurrence graphs, where node size reflected frequency and edge thickness indicated co-occurrence strength. K-means clustering analyzed keywords to generate semantically clear thematic labels, with convex hull algorithms delineating cluster boundaries. For density visualization, Gaussian kernel density estimation generates a heatmap illustrating keyword distribution density. In temporal analysis, a heatmap matrix displays keyword × year frequency distributions. An Overlay view employs color gradients to represent the average year of keyword emergence, visually revealing the temporal evolution of research themes.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePublication Evolution Trends and Quantitative Characteristics\u003c/h2\u003e \u003cp\u003eResearch on robot-assisted and 3D printing technologies in total knee arthroplasty has shown continuous growth since 2000. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the total number of publications increased from 1 in 2000 to 35 in 2025. The period from 2000 to 2014 constituted the nascent stage, characterized by sparse publications. Growth commenced in 2015, accelerated after 2018, and entered a phase of rapid expansion post-2020, with research momentum steadily increasing. By 2025, the cumulative literature volume reached 180 papers, exhibiting exponential growth.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom the perspective of technological pathways, robot-assisted research holds an absolute dominant position, with a total of 157 publications accounting for 87.2% of the literature. The 3D printing direction comprises 16 publications, primarily focused on intraoperative guide design and personalized osteotomy. Research integrating \u0026ldquo;robotics\u0026thinsp;+\u0026thinsp;3D printing\u0026rdquo; comprises only 7 publications, representing an emerging interdisciplinary field. The onset years for each research type show marked differences: robot-assisted research began as early as 2000, while 3D printing technology emerged only in 2016, reflecting a significant temporal gap in the maturity and penetration pathways of these two technologies. Categorized by research phase, the period from 2020 to 2025 is defined as the \u0026ldquo;rapid growth phase,\u0026rdquo; accounting for 133 publications (73.9% of the total). The remaining phases comprise the development stage (21.7%), exploratory stage (1.7%), and nascent stage (2.8%), further validating the field's entry into a concentrated growth phase.\u003c/p\u003e \u003cp\u003eAmong highly cited publications, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,the study \u0026ldquo;Total Knee Arthroplasty Assisted by 3D-Printed Customized Surgical Navigation Templates\u0026rdquo; from Guizhou Orthopedic Hospital received the highest citation count at 42. Institutions such as the Army Medical University, Nanjing Medical University, and the General Hospital of the People's Liberation Army made significant contributions in this field, with research covering key technical areas including 3D-printed guides, comparisons of domestic robotic systems, and postoperative alignment accuracy. These publications not only demonstrate the depth of domestic research in this domain but also highlight core issues concerning the optimization of TKA surgery through robotics and 3D printing.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of Top 10 Cited Publications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRanking\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDocument Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of citations (times)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003emechanism\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal knee replacement assisted by 3D-printed personalized surgical navigation template\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGuizhou Provincial Orthopedic Hospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA study on the improvement of femoral rotation alignment and early efficacy of robot-assisted total knee arthroplasty.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJoint Surgery Center, First Affiliated Hospital of Army Medical University (Southwest Hospital)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplication of 3D-printed surgical guides in total knee arthroplasty for patients with varus and valgus deformities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepartment of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University; Institute of Digital Medicine, Nanjing Medical University; Jiangsu Provincial Clinical Engineering Research Center for Digital Medicine and 3D Printing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA comparative study of the short-term efficacy of domestically produced \"Honghu\" orthopedic surgical robot-assisted surgery and traditional total knee arthroplasty.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepartment of Orthopedics, Fourth Medical Center of the PLA General Hospital; National Clinical Research Center for Orthopedics and Sports Rehabilitation; Nankai University School of Medicine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch on Robot-Assisted Total Knee Arthroplasty System and its Preclinical Application\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eShanghai Jiao Tong University\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplication of robot-assisted technology in total knee replacement surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepartment of Joint Surgery, Affiliated Hospital of Qingdao University\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Review of Clinical Applications of Joint Surgery Robots in 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePLA Medical College; Department of Orthopedics, Fourth Medical Center of the PLA General Hospital; National Clinical Research Center for Orthopedics and Sports Rehabilitation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA review of research on robot-assisted knee replacement surgery systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool of Mechanical and Electrical Engineering and Automation, Shanghai University\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChanges in surgery time and blood loss during total knee replacement surgery using 3D-printed personalized osteotomy molds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepartment of Orthopedics, Shenyang Military Region General Hospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobot-assisted minimally invasive total knee replacement surgery system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool of Mechanical Engineering and Automation, Beijing University of Aeronautics and Astronautics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn summary, the number of publications in this field is growing rapidly, with research themes clearly focused and a distinct path of technological evolution. Robot-assisted technology serves as the dominant approach, while 3D printing and integrated research demonstrate significant upward potential, indicating vast room for future development.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDistribution Structure of Research Entities\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, research on robot-assisted and 3D printing technologies in total knee arthroplasty exhibits a highly concentrated distribution of authors and institutions. Among high-output authors, Zhang leads with 10 publications, significantly ahead of others. Following are units or authors such as \u0026ldquo;Department of Orthopaedics,\u0026rdquo; \u0026ldquo;The Second Hospital of Shanxi Medical University,\u0026rdquo; \u0026ldquo;Taiyuan 030001,\u0026rdquo; and \u0026ldquo;Shanxi,\u0026rdquo; with publication counts generally ranging between 6 and 7, indicating stable research output capacity among certain teams in this field. Smith \u0026amp; Nephew also ranks prominently among corporate institutions, reflecting sustained industry interest in this technical pathway. Regarding journal distribution, English core journals account for 72.8% of publications. Among international journals, 131 papers were published in \u0026ldquo;foreign-language journals,\u0026rdquo; while the primary Chinese sources were Chinese Journal of Tissue Engineering Research and 《中国组织工程研究》, each hosting 7 papers. Distribution across other journals was relatively dispersed. Authors exhibit close collaboration, with most papers featuring 4\u0026ndash;8 authors and some exceeding 10 contributors. This reflects interdisciplinary and cross-institutional collaboration as a common research model in this field, facilitating technological integration and clinical application. Overall, the research landscape exhibits structural characteristics of \u0026ldquo;concentrated high-output authors, core journal clustering, and active collaborative networks,\u0026rdquo; indicating significant potential for internationalization, organizational synergy, and disciplinary convergence in this domain.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eResearch Hotspots and Knowledge Base\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the keyword frequency statistics, indicating that the research focus is highly concentrated on total knee arthroplasty and its key technical pathways. \u0026ldquo;Total knee arthroplasty\u0026rdquo; and \u0026ldquo;robotic\u0026rdquo; appeared 174 and 157 times respectively, forming the most central term combination in the current field. This reflects that technical research predominantly revolves around the clinical scenario of TKA, with robotic assistance serving as the primary technological support. Among high-frequency keywords, terms like \u0026ldquo;unicompartmental arthroplasty,\u0026rdquo; \u0026ldquo;clinical research,\u0026rdquo; \u0026ldquo;alignment,\u0026rdquo; and \u0026ldquo;accuracy\u0026rdquo; appear frequently, indicating that research content has gradually extended from technology introduction to surgical precision control and clinical efficacy validation. In terms of keyword composition, \u0026ldquo;total knee arthroplasty\u0026rdquo; and \u0026lsquo;robotic\u0026rsquo; collectively accounted for over 70% of mentions, indicating a highly concentrated research focus. In contrast, keywords like \u0026ldquo;3D printing,\u0026rdquo; \u0026ldquo;surgical guides,\u0026rdquo; \u0026ldquo;navigation,\u0026rdquo; and \u0026ldquo;personalization\u0026rdquo; appeared less frequently but carried distinct technological attributes, primarily associated with preoperative planning and the development of individualized treatment strategies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eConcurrently, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e also illustrates,the activity levels of terms such as \u0026ldquo;meta-analysis,\u0026rdquo; \u0026ldquo;therapeutic efficacy,\u0026rdquo; \u0026ldquo;prosthesis,\u0026rdquo; and \u0026ldquo;osteoarthritis\u0026rdquo; are also increasing, indicating a gradual shift in research focus toward long-term clinical evaluation and evidence-based support. The structural distribution of the keyword co-occurrence network further reveals intrinsic connections among terms. \u0026ldquo;Total knee arthroplasty,\u0026rdquo; \u0026ldquo;robotic,\u0026rdquo; \u0026ldquo;alignment,\u0026rdquo; and \u0026lsquo;accuracy\u0026rsquo; form the core region of the network, exhibiting strong connectivity and thematic dominance. While \u0026ldquo;3D printing,\u0026rdquo; \u0026ldquo;surgical guides,\u0026rdquo; and \u0026ldquo;navigation\u0026rdquo; are positioned at the network periphery, they maintain stable co-occurrence with core nodes, reflecting their auxiliary roles within the research framework. Density distribution analysis indicates that research hotspots primarily cluster in the high-density zone formed by \u0026ldquo;robotic-assisted total knee arthroplasty.\u0026rdquo; Secondary clusters include themes like \u0026ldquo;3D printing,\u0026rdquo; \u0026ldquo;meta-analysis,\u0026rdquo; and \u0026ldquo;unicompartmental knee arthroplasty,\u0026rdquo; revealing a distinct hierarchical structure in the hotspot distribution. The temporal evolution path reveals that early research focused on procedural fundamentals like \u0026ldquo;total knee arthroplasty,\u0026rdquo; \u0026ldquo;alignment,\u0026rdquo; and \u0026ldquo;prosthesis.\u0026rdquo; In recent years, keywords have progressively shifted toward \u0026ldquo;accuracy,\u0026rdquo; \u0026ldquo;personalization,\u0026rdquo; \u0026ldquo;efficacy,\u0026rdquo; and \u0026ldquo;meta-analysis,\u0026rdquo; indicating a growing emphasis on clinical outcomes and precision control. Notably, \u0026ldquo;3D printing\u0026rdquo; and \u0026ldquo;surgical guides\u0026rdquo; emerged relatively recently, reflecting their status as emerging technological growth areas. Clustering results validate these analyses, grouping keywords into four primary thematic clusters: technology-driven topics centered on \u0026ldquo;total knee arthroplasty\u0026mdash;robotics\u0026rdquo;; procedure optimization categories exemplified by \u0026ldquo;clinical research\u0026mdash;alignment\u0026mdash;3D printing\u0026rdquo;; Evidence-based evaluation focused on \u0026ldquo;unicompartmental arthroplasty\u0026mdash;meta-analysis\u0026mdash;outcomes\u0026rdquo;; and foundational clinical issues encompassing \u0026ldquo;accuracy\u0026mdash;prosthesis\u0026mdash;osteoarthritis.\u0026rdquo; Together, these form a relatively robust knowledge framework for the field.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn summary, robot-assisted technology is the core driver of this research field. Research focus is concentrated on intraoperative precision control and clinical efficacy evaluation. Emerging technologies such as 3D printing are gradually being integrated into the existing system, demonstrating positive potential in promoting deeper research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eResearch Frontier Dynamics and Technology\u003c/h2\u003e \u003cp\u003eComparison The distribution of technology types extracted from existing literature shows that \"robot-assisted\" technology dominates the research system, accounting for 87.2% (157 articles); \"3D printing\" related studies number 16 (8.9%); and while \"robot\u0026thinsp;+\u0026thinsp;3D printing\" integration studies only account for 3.9% (7 articles), they have already shown high development potential. Observing the time series, \"robot-assisted\" technology has grown rapidly since 2017, gradually forming the main research line, while \"3D printing\" and its integration paths, although starting later, are gradually attracting attention and have certain room for expansion. The relevant results are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFocusing on the keyword distribution over the past three years((Figs.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e), we can see that \"total knee replacement,\" \"robot,\" and \"clinical research\" have consistently appeared frequently, reflecting that precise operation, intelligent intervention, and clinical evidence remain the core directions of current research.\u003c/p\u003e \u003cp\u003eMeanwhile, Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a comparison between robot-assisted and 3D-printed guide-assisted TKA procedures,in June 2025, the world's first revision surgery using a domestically produced robot-assisted knee replacement, performed by the team led by Tian Hua at Peking University Third Hospital, combined with a personalized 3D-printed prosthesis system, was carried out on a complex revision procedure for a 73-year-old female patient. This case not only achieved the synergy between preoperative 3D modeling and intraoperative trajectory adjustment but also effectively solved technical bottlenecks such as inaccurate positioning, severe bone defects, and poor prosthesis stability during revision surgery, representing a cutting-edge breakthrough in the integrated application of robots and 3D printing. Comparative analysis shows that this case demonstrates significant advantages in multiple dimensions. The solution adopted by Tian Hua's team integrates robotics, personalized prostheses, and complex revision surgery, possessing highly autonomous and adjustable characteristics. In contrast, Huang Chenyu's team in 2021 used a 3D-printed guide plate only for preoperative positioning simulation in primary replacement surgery, while Wang Hongping's team's research in 2024 focused on comparing the two types of robotic systems, lacking personalized component design and not addressing intraoperative intelligent response or path control. In terms of surgical complexity, precision, and postoperative outcomes, Tian Hua's team's solution demonstrated superior performance in force line restoration, visual control, and operational efficiency. This achievement marks the first application of a domestically produced robotic system in knee revision surgery, showcasing high technological integration, independent intellectual property rights, and demonstrating the synergistic ability to achieve soft tissue balance, force line control, and prosthesis stability in complex scenarios. It also sets an important technological benchmark internationally.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Robot-Assisted and 3D Printed Guide Plate-Assisted TKA Procedures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eproject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobot-assisted TKA (Wang Hongping et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3D printed guide plate TKA (Huang Chenyu et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBRATKA group: 40 cases / HRATKA group: 53 cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrinting group: 20 cases / Control group: 19 cases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery time (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHRATKA group: 94.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrint count: 62.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCut length (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHRATKA group: 14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo clear report\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe printing group showed a significantly lower rate than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere were no significant differences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo serious complications were observed in the printing group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative alignment (HKAA angle)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificantly superior to the traditional group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe printing group alignment angle is better (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative KSS score (3 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificant improvement (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe printing group showed a higher rate than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score (postoperative pain)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe HRATKA group was significantly lower than the BRATKA group.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe printing group had lower pain scores one week post-surgery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical stability and controllability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher, especially excelling in complex surgeries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative simulation enhances predictability and facilitates intraoperative control.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonalized matching capabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh efficiency; the robotic system allows for intraoperative adjustments to the surgical plan.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelying on preoperative printing limits intraoperative flexibility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on current development trends, robot-assisted technology will maintain its mainstream position, with its capabilities in intraoperative precision control, path planning, and multidimensional feedback constituting key advantages. The value of 3D printing in personalized prosthesis design is gradually emerging, especially in complex cases and revision surgeries, demonstrating unique adaptability. In the future, the deep integration of these two technologies is expected to construct a new paradigm of intelligent surgery that is visible, controllable, and quantifiable, becoming a core standard for evaluating next-generation surgical techniques.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eKey Findings\u003c/h2\u003e \u003cp\u003eBased on a quantitative and visual analysis of 180 articles published between 2000 and 2025, this paper systematically reviews the research trends and knowledge structure of robot-assisted and 3D printing technologies in total knee arthroplasty. The results show that this field has entered a period of rapid development since 2017, with the number of publications reaching its peak in 2025. The main research focus is on Chinese and some international orthopedic centers, with most articles concentrated in core foreign journals, demonstrating a clear international character. Keywords focus on terms such as \"total knee replacement,\" \"robotics,\" \"3D printing,\" and \"personalization,\" with research centered on precise intraoperative control and postoperative force line restoration. Robot-assisted technology accounts for 87.2%, maintaining its absolute dominance; 3D printing is gradually being embedded in preoperative planning and individualized design, and its integration pathway is being explored. The robotic\u0026thinsp;+\u0026thinsp;3D printing revision surgery practice conducted by Peking University Third Hospital in 2025 marks the entry of the synergistic application of these technologies into the clinical validation stage. The overall trend points to the development path of \"precise alignment \u0026ndash; ​​biomechanical matching \u0026ndash; intelligent assisted surgery,\" providing direction for future research and technology implementation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePublication Trend Evolution\u003c/h2\u003e \u003cp\u003eFrom 2000 to 2025, research on robot-assisted and 3D printing technologies in the TKA field has shown a phased growth trend. In the early stages, it was in the theoretical exploration and pilot phase, with the average annual number of publications remaining in single digits from 2000 to 2014, showing slow growth. After 2015, the field entered an expansion phase, with the number of publications steadily increasing to 14 in 2019. Research gradually formed a systematic framework and accelerated its practical application driven by clinical trials in China, the US, and the UK. The period from 2020 to 2025 represents a rapid development phase, with publications during this period accounting for over 80% of the total, reaching 35 in 2025. The cumulative total increases from 69 in 2020 to 180, indicating a maturing research ecosystem and the technology moving towards clinical standardization. Robot-assisted research saw the most significant growth, accounting for 87.2% and maintaining a dominant position. 3D printing literature started later, accumulating only after 2016. While fusion technologies emerged in 2015, only 7 articles have been published, indicating an initial transitional stage, although their application potential has already been demonstrated in some cases. The phase-by-phase statistics show that the rapid growth period accounts for 73.9%, exhibiting a typical concentrated explosive growth characteristic, with research driven by a high degree of dependence on technological development and clinical feedback. Overall, research themes have shifted from macro-level frameworks to intraoperative precision, cost control, and long-term effects, demonstrating a high degree of consistency between technological evolution and research enthusiasm.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eHot Topics and Knowledge Base\u003c/h2\u003e \u003cp\u003eA keyword co-occurrence analysis based on 180 articles shows that research in the TKA field is highly concentrated. \"Total knee replacement\" (174 times) and \"robot\" (157 times) are the most frequent keywords, forming the core issue framework of the field. Keywords such as \"3D printing,\" \"personalized,\" \"alignment,\" \"accuracy,\" and \"meta-analysis\" collectively form a knowledge structure centered on technological implementation, intraoperative control, and clinical assessment. The co-occurrence network shows a strong association between \"robot\" and terms such as \"alignment\" and \"prosthesis,\" reflecting its crucial role in intraoperative precision control; \"3D printing\" is more associated with \"guide plate\" and \"revision,\" demonstrating its adaptability in personalized procedures and complex cases. The temporal evolution trend indicates that \"robot\" has been gaining popularity since 2015, while \"3D printing\" and \"personalized\" have grown rapidly in recent years, reflecting a positive trend in research towards integrating technology with clinical evidence. Cluster analysis identified four main themes covering surgical innovation, efficacy evaluation, preoperative planning, and revision surgery, indicating that this field is entering an integrated development stage centered on high precision, individualization, and systematic evaluation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of Technological\u003c/b\u003e Advancements Currently, in total knee arthroplasty, robot-assisted and 3D-printed surgical guides demonstrate their respective significant advantages and application differences. Robot-assisted technology, with its real-time feedback capabilities in intraoperative navigation, precise osteotomy, and force line adjustment, has achieved good results in improving prosthesis placement accuracy and postoperative lower limb force line recovery. For example, a comparison between the domestic HURWA and imported Brainlab Knee3 systems by Wang Hongping et al. showed that both have significant advantages in imaging indicators, but no significant difference has yet been observed in postoperative functional improvement. In contrast, 3D-printed surgical guides, with their core focus on preoperative personalized design, can effectively optimize osteotomy plans and shorten surgical time in patients with complex deformities. As shown in the study by Huang Chenyu et al., the 3D-printed group outperformed the traditional group in terms of intraoperative blood loss, postoperative VAS score, and KSS score. Compared to the technologies mentioned above, the \"robot\u0026thinsp;+\u0026thinsp;3D printed prosthesis\" combined approach reported by Tian Hua's team in 2025 achieved a breakthrough in the integrated process from preoperative modeling to intraoperative navigation in complex revision surgery scenarios. This significantly improved the adaptability and mechanical alignment accuracy of bone defect repair, marking a shift in the field from a single technology to a multi-faceted integrated development.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Prospects\u003c/h2\u003e \u003cp\u003eThis study reviewed the research hotspots, technological trends, and cutting-edge developments of robot-assisted and 3D printing technologies in total knee arthroplasty. However, certain limitations remain in the research design and data sources. The literature scope was limited to Chinese and English databases on Google Scholar and CNKI platforms from 2000 to 2025, which may have omitted some conference papers, grey literature, and important unpublished results, potentially affecting the comprehensiveness of the conclusions. In the keyword extraction and cluster analysis process, inconsistencies in sample labeling and missing information may affect the accuracy of the co-occurrence network and the stability of the cluster structure. While the technical pathway analysis has constructed a relatively clear knowledge structure, it has not yet explored in depth key clinical factors such as implementation costs, learning curves, and individual patient differences, limiting the applicability of the results in practical application. Future research should incorporate multi-center real-world data to systematically validate efficacy differences from multiple dimensions, including pathological type, technological generation, and surgeon experience. Simultaneously, it should accelerate the development of standards and evaluation systems to promote the rapid evolution of TKA intelligent technology from an auxiliary tool to a standardized procedure, enabling the sustainable clinical implementation of precision orthopedics.。\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study, based on 180 Chinese and English articles published between 2000 and 2025, systematically presents the research evolution trends, technical pathways, and thematic focuses of robot-assisted and 3D printing technologies in total knee arthroplasty (TKA) through bibliometric analysis and knowledge graph construction. Results show that robotics has accelerated its development since 2015, gradually becoming the dominant means of achieving standardization and precision in TKA, accounting for the absolute majority of the literature. 3D printing, on the other hand, is mainly applied to preoperative planning, guide plate customization, and deformity correction, demonstrating significant advantages in specific clinical scenarios. In 2025, the integration of these two technologies will be applied for the first time in knee revision surgery, marking the entry of this field into a composite integration stage. Keyword co-occurrence and clustering results reflect that the research focus is shifting from intraoperative control to preoperative modeling and postoperative force line reconstruction. Core terms such as \"alignment,\" \"guide plate,\" and \"personalization\" construct the evaluation framework.\u003c/p\u003e \u003cp\u003eThe number of Chinese researchers continues to grow, with a number of domestic teams gradually establishing influence on international platforms, and domestic research pathways becoming increasingly mature. Currently, there are still problems such as insufficient standardized assessment, limited data accumulation, and insufficient depth of technical collaboration. It is necessary to strengthen the integrated mechanism research of preoperative, intraoperative, and postoperative procedures, improve the multi-center empirical basis, and construct an intelligent TKA surgical system guided by precise alignment, functional recovery, and long-term stability.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eReview\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eOverview of Total Knee Arthroplasty Research\u003c/h2\u003e \u003cp\u003eAs the standard treatment for end-stage knee osteoarthritis (KOA), TKA has a clear effect on relieving pain, restoring knee joint function, and improving quality of life, and has become a widely performed routine surgery in orthopedic clinics worldwide. Since my country entered a period of accelerated aging, the annual number of this procedure has continued to climb. According to a report published by Zhang Siwei on June 19, 2025, more than 480,000 related surgeries were performed in 2020, nearly nine times the number in 2011. The demand for revision surgeries also increased simultaneously, exceeding 50,000 cases that year, accounting for about 10%, reflecting the simultaneous increase in technical complexity and clinical pressure. Surgical robots, as an emerging technological approach, are gradually changing the implementation mode of TKA. Research evidence shows that these systems demonstrate significant advantages in improving surgical precision, stabilizing prosthesis alignment, and enhancing patient satisfaction (Hu Jialiang et al., 2025). Domestically produced systems such as \"Honghu,\" \"Hehua,\" and \"HURWA\" have been clinically deployed, forming a diversified technological landscape alongside international brands like Mako and ROSA. \"Honghu\" shows stable performance in postoperative HKA angle, joint range of motion, and complication control (An Haoming et al., 2023); \"Hehua\" achieves navigation accuracy within 95% of 1 mm, with outstanding operational consistency (Heng Chunning et al., 2025); HURWA and Brainlab Knee3 each have advantages in postoperative force line recovery, with essentially the same short-term efficacy (Wang Hongping et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The ROSA system has attracted attention due to its clear control over HKA angle and ROM, with intraoperative osteotomy errors mostly controlled within 2 mm and a relatively short learning cycle (Wang Fan, 2023). The Mako surgical procedure combines the advantages of trauma control and rapid recovery, allowing patients to walk within 24 hours post-surgery with minimal nursing intervention (Sun Ying and Lu Jike, 2025).\u003c/p\u003e \u003cp\u003eFrom a developmental perspective, robot-assisted total knee arthroplasty (TKA) has moved from the experimental stage to widespread application, becoming a crucial engine for promoting precision and minimally invasive orthopedic surgery. In challenging scenarios such as complex deformities, revision surgeries, and personalized reconstructions, the value of this technology continues to expand, with significant future potential in areas such as intraoperative navigation fusion, multimodal imaging support, and integrated workflow optimization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eResearch Progress in Robot-Assisted Total Knee\u003c/h2\u003e \u003cp\u003eArthroplasty The application of intelligent medical technology in clinical orthopedics continues to deepen. Robot-assisted surgery and 3D printing are widely used in total knee arthroplasty, demonstrating significant advantages in intraoperative precision control and operational stability, and are gradually driving the transformation of traditional surgical procedures towards precision. Related studies indicate that 3D-printed surgical guides are clinically superior to traditional techniques in knee deformity correction, showing better performance in terms of intraoperative blood loss, postoperative drainage, and operation time. Early KSS scores and pain relief indices also show significant improvements (Huang et al., 2021). Furthermore, prospective studies have confirmed that 3D-printed assisted total knee arthroplasty (TKA) has comprehensive advantages in intraoperative efficiency, perioperative risk control, and functional recovery, reducing intraoperative blood loss, shortening operation time, lowering the incidence of complications, and achieving better AKS, Lysholm, and IKDC scores than the traditional group (Peng and Zhang, 2023).\u003c/p\u003e \u003cp\u003eIn the field of medical education, there have been explorations combining robot design with 3D-printed models for TKA simulation training. Related research shows that this model helps improve learners' mastery of surgical procedures and understanding of key technical operations, alleviating the problem of insufficient practical experience and effectively shortening the learning cycle (Huang et al., 2022).\u003c/p\u003e \u003cp\u003eBased on current progress, the application of robot-assisted total knee arthroplasty (TKA) and 3D-printed surgical guides has expanded from intraoperative precision control to multiple levels, including preoperative planning and teaching practice. Future research should focus on long-term efficacy assessment, clinical adaptability validation in complex cases, and the potential for deep integration in highly complex surgical procedures, promoting the evolution of multi-technology collaboration towards standardized clinical pathways.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eApplication Research of 3D\u003c/h2\u003e \u003cp\u003ePrinting Technology in Total Knee Arthroplasty With the deepening of personalized medicine concepts, the application of 3D printing technology in total knee arthroplasty is constantly expanding, gradually becoming an important research direction in this field. It demonstrates high adaptability in preoperative assessment, guide customization, and precision control of intraoperative osteotomy and prosthesis implantation. Related studies have shown that 3D-printed navigation templates significantly improve the accuracy of lower limb alignment correction, while also reducing surgical time, intraoperative bleeding, and postoperative drainage, thus helping to accelerate perioperative recovery (Huang et al., 2021). In terms of postoperative functional recovery, this technology has also shown good results, manifested in increased knee joint range of motion, improved functional scores, and reduced complication rates, gradually demonstrating its clinical value (Peng Liangzhen and Zhang Fenghai, 2023).\u003c/p\u003e \u003cp\u003eBeyond treatment, 3D printing is being widely introduced into auxiliary processes such as teaching training and preoperative simulation. Existing research has explored the combined application of robotic surgical design with 3D-printed simulation models in TKA simulation teaching, which not only improves operators' understanding of complex surgical structures but also alleviates the problem of insufficient clinical practice opportunities to some extent (Huang Ying et al., 2022). Retrospective studies by international teams have further validated the effectiveness of this technology in preoperative planning. Capece analyzed intraoperative data from 300 patients with mild knee deformities, showing that a robotic preoperative planning system combined with 3D printing could accurately predict prosthesis size and alignment parameters, achieving excellent intraoperative matching results, and simultaneously improving operational stability and postoperative alignment accuracy (Capece et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The application of 3D printing technology in total knee arthroplasty (TKA) has expanded from a single intraoperative aid to diversified end-to-end surgical management. Its role in improving precision treatment, perfecting the teaching system, and supporting decision-making is gradually deepening, and its future development potential deserves continued attention.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eComprehensive Application of Precision Orthopedic Techniques\u003c/h2\u003e \u003cp\u003eThe introduction of high-precision technologies has driven the transformation of orthopedic diagnosis and treatment processes towards individualization, visualization, and intelligence, which is particularly evident in total knee arthroplasty. Current clinical practice places greater emphasis on the accuracy of preoperative planning, the precision of intraoperative procedures, and the predictability of postoperative functional recovery. Robot-assisted surgical systems and imaging simulation technology have become important means to improve surgical quality. A study by Hu Jialiang et al., based on 55 patients, found that ROSA robot-assisted TKA was superior to traditional methods in terms of prosthesis implantation precision, lower limb alignment, and early postoperative ROM (Hu Jialiang et al., 2025). Wang Fan further confirmed from the perspectives of randomized controlled trials and learning curves that the system was highly consistent with the preoperative plan in terms of osteotomy precision and operational stability, with errors mostly controlled within 2mm or 3\u0026deg;, and a stable level could be achieved in about 10 surgeries, demonstrating a low learning cost (Wang Fan, 2023). Overall, robotic systems represented by ROSA have achieved collaborative management of multiple stages\u0026mdash;preoperative, intraoperative, and postoperative\u0026mdash;reflecting the trend of orthopedic surgery towards refinement and intelligence.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eBibliometrics and Knowledge Graph Related Research\u003c/h2\u003e \u003cp\u003eThe deep integration of precision orthopedic technology in clinical scenarios has promoted the systematic development of research on the application of robots and 3D printing, with related fields gradually entering a stage of structural organization and dynamic mining. Bibliometrics and knowledge graph analysis, while identifying research growth trends, geographical distribution patterns, and author collaboration networks, also demonstrate outstanding value in revealing terminology clusters, thematic structures, and frontier shifts. In joint replacement research, analysis based on Scopus data indicates that the United States and the United Kingdom are high-incidence areas for research, with total knee arthroplasty constituting the dominant surgical procedure. Research focuses on precise implantation and personalized prosthesis positioning (Kow et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The continuous iteration of robotic systems, such as ROBODOC, Mako, and Da Vinci, is driving the transformation of surgical techniques from traditional approaches to high-precision and intelligent collaborative systems. Despite cost and regulatory constraints, the overall development momentum remains strong (Hu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In spinal surgery, frequently occurring keywords focus on \"navigation,\" \"precision,\" and \"screw placement.\" Meanwhile, \"artificial intelligence integration\" and \"feasibility\" are terms appearing more frequently in mutation analysis, reflecting a gradual shift in technological focus from passive navigation to intelligent operating systems (Huang et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2026\u003c/span\u003e). Clustering and topic mining of 2312 relevant articles on the expanded application of 3D printing in bone tumors revealed its strong cross-disciplinary integration potential in preoperative modeling, postoperative reconstruction, radiotherapy adjuvant therapy, and drug resistance mechanism simulation, providing methodological support for personalized treatment (Yu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). A network meta-analysis of seven hip replacement robotic systems showed positive effects in postoperative length difference control, intraoperative bleeding, and infection rates. Performance differences between systems also provided quantitative evidence for subsequent technology selection and parameter evaluation (Wu et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt the Chinese research level, relevant reviews indicate that although research on robotic technology in unicompartmental, patellofemoral, and total knee surgeries is increasingly active, there is currently a lack of maturity assessment and systematic quantitative analysis. Bibliometric methods need to be introduced to improve the research framework and promote structural analysis (Qiao Hua and Li Huiwu, 2023).\u003c/p\u003e \u003cp\u003eOverall, research on the application of robotics and 3D printing technologies in orthopedic surgery has entered a stage of systematic integration. Bibliometrics, as an important tool for research evolution identification and strategic planning, is playing an increasingly crucial role in multi-database fusion, interdisciplinary collaboration, and visual representation.。\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eEthics declaration\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eNot applicable\u003c/h2\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Beijing Natural Science Foundation \u0026ndash; Changping Joint Fund, Grant No. 25L40160\u003c/p\u003e\n\u003cp\u003e2.Major Science and Technology Special Program of Yunnan Province (Biomedical Special Project), Grant No. 202502AA310005\u003c/p\u003e\n\u003cp\u003e3.Joint General Program of China-Japan Friendship Hospital and Beijing University of Chemical Technology, Grant No. 2025-NHLHCRF-YXHZ-MS-04 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.National Key Research and Development Program of China, Grant No. 2023YFC2507601\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHeng Chun-ning et al. Li Ke-xin, Luo Han-wen,. Early clinical study of total knee arthroplasty assisted by domestic joint surgery robot[J]. Chinese Journal of Rehabilitation Medicine, 2025, 34(12):90\u0026ndash;96.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13517/j.cnki.ccm.2025.12.021\u003c/span\u003e\u003cspan address=\"10.13517/j.cnki.ccm.2025.12.021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Jia-liang, Ma Rui-xiang, Abbas Maimaiti Abula, et al. Comparative study on the short-term efficacy of ROSA orthopedic surgical robot-assisted and traditional total knee arthroplasty[J]. Chinese Journal of Orthopedics and Traumatology, 2025, 38(10):1009\u0026ndash;1018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYing S. Lu Ji-ke. Cooperation of Mako orthopedic surgical robot-assisted total knee arthroplasty[J]. 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Int J Surg, 2025: 101097.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total knee arthroplasty, Robot-assisted, 3D printing, Bibliometrics","lastPublishedDoi":"10.21203/rs.3.rs-9086357/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9086357/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study systematically reviews the research trends in robot-assisted and 3D printing technologies for total knee arthroplasty (TKA) from 2000 to 2025, employing bibliometric and knowledge graph analysis methodologies. By retrieving relevant Chinese and English literature from CNKI and Google Scholar databases, 180 high-quality research papers were selected and included. Information such as publication trends, research entities, thematic hotspots, technology types, and frontier dynamics were extracted and analyzed. Results indicate that research in the TKA field has grown rapidly since 2016, with robot-assisted technology dominating, while 3D printing applications have gradually expanded to preoperative planning, guide plate fabrication, and personalized prostheses. Clustering and keyword co-occurrence analysis revealed research hotspots centered on core issues such as \u0026ldquo;osteotomy precision,\u0026rdquo; \u0026ldquo;postoperative alignment restoration,\u0026rdquo; and \u0026ldquo;prosthesis positioning.\u0026rdquo; Research frontiers are evolving toward intelligent robotic systems, personalized 3D printing, and biocompatible materials. Combining domestic and international case studies, this paper compares the clinical performance of multiple domestic and imported surgical robotic systems, noting the increasing maturity of domestic systems in terms of accuracy, stability, and learning curves. Finally, the study addresses current limitations and future directions, emphasizing the critical value of multimodal fusion and intelligent decision-making systems in precision medicine for TKA.\u003c/p\u003e","manuscriptTitle":"Global Research Trends in Robot-Assisted and 3D Printing Technologies for Total Knee Arthroplasty: An Analysis Based on Bibliometrics and Knowledge Graphs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 17:07:08","doi":"10.21203/rs.3.rs-9086357/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8bcfab4-96bb-42bb-bfed-888d976c0474","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-04-29T23:01:00+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T23:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 17:07:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9086357","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9086357","identity":"rs-9086357","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}