Abstract Abrasive water suspension jet (AWSJ) machining on carbon fiber-reinforced polymer (CFRP) composite-based orthopedic implants yielded insightful results based on experimental data and subsequent statistical validations. Underwater AWSJ cutting consistently outperformed free air cutting, with numerical findings demonstrating its superiority. For instance, at #100 abrasive size and 5 mm standoff distance (SOD), the material removal rate (MRR) peaked at 2.44 g/min with a kerf width of 0.89 mm and a surface roughness (SR) of 9.25 µm. Notably, the increase in abrasive size correlated with higher MRR values, such as achieving 2.15 g/min at #120 grit and 3 mm SOD. Furthermore, optimization techniques like the Taguchi method and response surface methodology (RSM) were applied to refine machining parameters. These methodologies enhanced MRR, exemplified by achieving 2.10 g/min with #120 abrasive size and 5 mm SOD in underwater cutting conditions. The research explored the impact of key process parameters, namely, the speed, feed, and SOD on the MRR, kerf width, and SR in both free air cutting and underwater cutting conditions, which is one of the novel research endeavors in the domain of abrasive jet machining of composites.