Lower limb alignment and soft tissue balance are important factors affecting patient satisfaction, clinical functional outcome, and prosthetic long-term survival rate after total knee arthroplasty (TKA). Robot-assisted TKA (rTKA) has the advantages of achieving precise osteotomy and soft tissue balance. However, rTKA under the guidance of classic mechanical alignment principles does not significantly improve the functional outcome after operation. The new TKA alignment principles, such as kinematic alignment (KA) and functional alignment (FA), can better consider the patient’s own knee joint morphology and kinematic characteristics, which may help improve the clinical results of TKA. With the help of more objective and accurate soft tissue balance assessment tool such as pressure sensors, KA and FA have been proven to better achieve soft tissue balance. rTKA can achieve non-neutral alignment goals such as KA or FA more accurately and reproducibly. The use of these lower limb alignment and soft tissue balancing strategies will be expected to further increase the patients’ satisfaction rate after rTKA.
