Surgeon decision-making and implant selection in primary total knee arthroplasty: association of training, experience, and robotic-assisted surgical innovation with implant selection.

Introduction: Implant selection in primary total knee arthroplasty (TKA) remains a critical yet variable aspect of surgical decision-making, associated with both patient characteristics and surgeon-related factors. With the increasing integration of surgical innovations such as robotic-assisted techniques, understanding contemporary determinants of implant choice has become essential. This study aimed to evaluate implant selection patterns and identify independent factors associated with the use of cruciate-retaining (CR) vs. posterior-stabilized (PS) implants in a modern clinical setting. This study was designed as a retrospective observational analytical study, with data analyzed within a cross-sectional framework. Methods: A cross-sectional study was conducted on 280 patients undergoing primary TKA at a high-volume tertiary care center between May 2024 and April 2025. Data on patient demographics, clinical characteristics, and implant-related variables were collected. Surgeon-level factors, including fellowship training, years in practice, and use of robotic or navigation systems, were also analyzed. Multivariate logistic regression was performed to identify independent factors associated with the CR implant selection. Results: CR implants were used in 60.0% of cases, whereas PS implants were used in 40.0% ( Conclusion: Implant selection in primary TKA is influenced by a combination of surgeon training and experience, patient characteristics, and the adoption of surgical technologies such as robotic assistance. These findings highlight the impact of surgical innovation on decision-making in modern arthroplasty practice and underscore the need for standardized, evidence-based approaches to reduce variability in implant selection.