Robotic Total Knee Replacement

Restoring mobility and comfort through careful planning and precision surgery

What is a knee replacement?

Knee replacement (total knee arthroplasty) involves resurfacing the damaged joint surfaces with precisely engineered implants designed to restore stable, smooth knee movement.

The aim is not simply to reduce pain, but to improve confidence and function during everyday activities such as walking, climbing stairs, and standing from a seated position.

Surgical planning considers individual anatomy, limb alignment, activity level, and personal goals, allowing the procedure and rehabilitation program to be tailored rather than following a one-size-fits-all approach.

Why consider robotic-assisted knee replacement

Robotic-assisted knee replacement is a tool that supports accuracy and consistency during surgery. Robotic systems assist with pre-operative planning and intra-operative guidance, helping optimise implant positioning and knee balance.

Robotic assistance allows the surgeon to:

Create a detailed pre-operative plan using a 3D CT-based model
Assess alignment, implant sizing, and joint mechanics before surgery
Work within defined boundaries to help protect surrounding soft tissues
Fine-tune knee balance using real-time feedback during the procedure

The robot does not perform the surgery. All steps are controlled by the surgeon, with robotic guidance used to support precise execution.

Techniques used in knee replacement

Several techniques may be used to assist knee replacement surgery:

Uses manual guides (jigs) to make bone cuts based on anatomical landmarks. This method is effective but subject to natural anatomical variation.
Uses trackers and computer guidance to reduce variation and improve alignment accuracy.
Uses pre-operative imaging to create customised cutting guides. Implants themselves are not customised, and accuracy still depends on intra-operative fit.
Uses a CT-based 3D model and robotic arm guidance to support accurate bone preparation and implant positioning. Current evidence demonstrates improved accuracy; longer-term outcome studies are ongoing.

How MAKO robotic knee replacement works

A CT scan is used to create a 3D model of the knee. This allows detailed planning of implant size, alignment, and positioning.
Key anatomical points are mapped during surgery to confirm the accuracy of the virtual model.
Bone surfaces are prepared within pre-planned boundaries, with robotic guidance assisting precision.
Real-time motion analysis helps ensure smooth knee movement, allowing fine adjustments where required.
Prosthetic components are positioned according to the surgical plan, with final adjustments guided by knee motion and soft-tissue tension.

Advantages of robotic-assisted knee replacement

Current evidence suggests robotic assistance may offer:

Greater accuracy in implant alignment
Consistent bone preparation according to the surgical plan
Less disruption of surrounding soft tissues, which may reduce early post-operative discomfort
Potential for shorter hospital stays

For partial knee replacement, early Australian registry data demonstrates lower revision rates with robotic assistance in the short term. Long-term outcome data for total knee replacement continues to evolve.

Considerations & limitations

Robotic surgery may take slightly longer than conventional methods
Specialised equipment and accreditation are required, so availability varies
Tracking pins are used; pin-site complications are uncommon but can occur
Long-term outcome data continues to develop

Robotic knee replacement is performed using the MAKO system with well-established prostheses for both total and partial knee replacement.

How knee replacement surgery is performed

Imaging and planning software assess alignment and determine optimal implant positioning.
Worn cartilage and a thin layer of bone are removed from the femur and tibia.
Metal and medical-grade polyethylene components are fitted to restore a smooth, stable joint.
The undersurface of the kneecap may be resurfaced depending on cartilage wear and symptoms.
Stability, balance, and range of motion are carefully assessed before wound closure.

Recovery & Rehabilitation

Rehabilitation begins soon after surgery and is tailored to functional goals. Recovery focuses on restoring mobility, strength, balance, and confidence.

Typical recovery milestones:

1–2 weeks: Early walking with support; swelling and wound care
6 weeks: Improved mobility, strength, and gait
3 months: Return to low-impact exercise such as cycling or swimming
12 months: Continued improvement in strength, balance, and comfort

Recovery timelines vary between individuals.

Total Knee Replacement Rehabilitation Protocol

Key Points to Remem

Knee replacement aims to restore mobility, function, and quality of life
Robotic assistance supports surgical precision but does not replace surgical judgement
Each knee replacement is planned individually based on anatomy, alignment, health, and goals
Rehabilitation is essential and is coordinated with your physiotherapist and GP

Frequently asked questions - Robotic Knee Replacement

Knee replacement is usually considered when pain, stiffness, or loss of function significantly affects daily life and does not improve with non-operative treatment. Suitability is assessed based on symptoms, imaging, and goals.
Knee replacement is most commonly performed for osteoarthritis. It may also be recommended for inflammatory arthritis, post-traumatic arthritis, or other degenerative conditions.
Robotic knee replacement uses computer-assisted planning and robotic guidance to support accurate implant positioning and alignment. The surgeon performs the procedure, with robotic systems providing guidance and safeguards.
Robotic assistance improves the accuracy and consistency of implant positioning. While long-term outcomes for total knee replacement continue to be studied, current evidence supports improved surgical precision.
Most patients stay 1–3 nights, depending on mobility, pain control, and home support.

Most patients begin walking with physiotherapy support on the day of surgery or the following day. Walking aids are gradually reduced as strength improves.
You can usually return to driving once you can safely perform an emergency stop, are off strong pain medication, and feel confident controlling the vehicle.
As a guide:
- Right knee: 4–6 weeks
- Left knee (automatic): 2–3 weeks
- Desk-based work: often 2–6 weeks
- Physically demanding work: 8–12 weeks or longer
Modern knee replacements are designed to last 15–20 years or more, depending on factors such as implant positioning, activity level, and overall health.
Risks are similar to conventional knee replacement and include infection, blood clots, stiffness, and implant-related issues. These are discussed in detail during consultation.

Key Takeaways

Robotic knee replacement is a tool that supports precision and personalisation. Successful outcomes depend on careful planning, surgical expertise, and committed rehabilitation.