Robotic-assisted total knee replacement surgery

What is robotic-assisted total knee replacement?

As its name suggests, this procedure is a total knee replacement surgery that is carried out with the assistance of robotic technology. This cutting-edge technique offers a number of benefits over conventional surgery, including improved implant alignment and bone preparation with less surgical dissection and faster recovery.

The most common question that many people have is, “does the robot perform the surgery, or does it assist the surgeon”. In this case, your surgeon performs the entire procedure from start to finish, with the robotic technology purely being used to help support the process through enhanced precision and accuracy.

Total knee replacement vs partial knee replacement: what is the difference?

The knee is comprised of three main compartments – the medial, the lateral and the patellofemoral. In a partial knee replacement, only the damaged compartments are removed and replaced. In a total knee replacement, all three are replaced.

What conditions may require robotic-assisted total knee replacement surgery?

Robotic-assisted total knee replacement surgery may be recommended for a variety of different conditions, including:

• moderate to severe pain and stiffness caused by osteoarthritis
• rheumatoid arthritis, which is a chronic autoimmune response where your body attacks the lining of your joints
• long-term damage following injury, for example a knee fracture
• complex deformities, such as from an accident or injury.

Your consultant will be able to advise you if your condition could benefit from a total knee replacement.

Is robotic-assisted knee replacement surgery a new technology?

Although it sounds like it might be a new technology, computer-assisted total knee replacements have been carried out in the UK since the late 1980s. However, the use of robots in computer-assisted surgery was only around a decade or two before it was more broadly adopted at hospitals across the UK.

What robotic systems are used in Nuffield Health’s total knee replacement surgeries?

We currently use two different robotic systems to perform total knee replacement surgeries.

MAKO® robotic-arm assisted surgical system

This is our primary choice of technology for robotic-assisted total knee replacement surgeries. MAKO® has been established for more than 15 years and is now used in NHS as well as private hospitals in the UK, as well as in more than 29 different countries around the world.

The system creates a personalised 3D scan of your knee to design a custom plan for your surgery, as well as using a robotic arm to follow this blueprint with complete precision and control. The MAKO® system enables more precise implant positioning, soft tissue protection and better healthy bone preservation, reducing the risk of complications and accelerating recovery.

CORI® robotic-assisted surgical system

The CORI® robotic-assisted surgical system is a handheld, portable robotic device. Unlike the MAKO® system, it doesn’t require any pre-operative imaging and instead enables an imaging-free approach to the surgery. As a result, CORI® offers minimal exposure to pre-operative radiation compared to the MAKO® system.

What are the differences between robotic and conventional total knee replacements?

Technology is continuing to transform healthcare, and total knee replacements are no exception. The main difference between robotic and conventional knee replacements is the accuracy of the planning and execution of the procedure itself. Robotic-assisted knee replacement techniques use cutting-edge 3D computer planning to determine exactly how the procedure will be performed, while conventional surgery relies entirely on manual planning.

Evidence suggests that robotic-assisted knee replacement surgery is usually more accurate in terms of precision and alignment. However, outcomes in terms of pain relief, returning function in the knee joint after surgery, and complication risk are all fairly equal to conventional total knee replacement surgery.

If you opt for robotic-assisted total knee replacement surgery over conventional surgery, you may have a lower risk of complications too. It’s widely accepted that using robotic techniques helps to reduce the margin of error for elements such as making incisions and positioning the artificial implant.

What are the benefits of robotic-assisted knee replacement?

Some of the most common benefits associated with using robotic-assisted knee replacement include:

• greater precision in planning and executing the surgery
• more consistent results
• reduced risk of complications with less surgical dissection.
• greater personalisation in your care
• better soft tissue preservation, as the robot can create virtual boundaries that prevent surgical tools from damaging healthy structures

Some studies also suggest that people who choose robotic-assisted knee replacement have a faster and more straightforward recovery.

How accurate is robotic-assisted total knee replacement?

Robotic-assisted total knee replacement surgery is largely considered to be extremely accurate, with the 3D offering an unrivalled level of precision at both the planning and execution stages of the treatment.

How do I know if I need robotic-assisted total knee replacement?

Your consultant will be able to advise you if a robotic-assisted total knee replacement is the best choice of treatment for you, based on your individual medical history and circumstances.

Who is a good candidate for robotic-assisted total knee replacement?

Good candidates for this surgical technique include healthy adults with moderate to severe pain or damage, with other less-invasive treatment options not providing effective relief from discomfort, or better range of motion.

Who is not suitable for robotic-assisted total knee replacement surgery?

If you’ve previously had a failed replacement surgery, you almost certainly won’t be a suitable candidate for robotic-assisted total knee replacement surgery. You may also be refused the procedure if you:

• have an active infection
• are diagnosed with severe osteoporosis
• are diagnosed with a neuromuscular disease
• are very overweight or obese
• have severe knee deformities.

What are the alternatives to total knee replacement surgery?

Surgery is only ever recommended as a final line of treatment. Before you reach this stage, there will be a variety of other therapies and procedures you may be asked to try to relieve your symptoms. These include:

Weight loss and exercise: Being overweight or obese puts excess strain on the joint. Losing weight and taking part in regular physical activity can reduce load on the knee and improve overall mobility.

Pain and topical medications: Pain-relieving medications and some topical treatments such as creams and gels can help to ease swelling, inflammation and discomfort, particularly in the months and weeks before surgery.

Injectable treatments: There’s a variety of injectable treatments including steroid, Hyaluronic acid, Arthrosamid®, and Platelet-Rich Plasma (PRP) injections, which can all be used to treat various conditions affecting the knee joint.

Autologous chondrocyte implantation (ACI) surgery can be used to repair large, full-thickness cartilage damage and defects.

Microfracture: This is another cartilage repair technique that’s used to repair smaller defects and areas of damage.

Partial knee replacement: Only one compartment of the knee is replaced. This may be suitable for some patients with early-stage osteoarthritis.

Knee osteotomy: reshapes the shinbone or thighbone to shift weight off damaged cartilage. This may be suitable for some patients with early-stage osteoarthritis.

How can I prepare for robotic-assisted total knee replacement surgery?

You should prepare for robotic-assisted total knee replacement surgery in exactly the same way as conventional knee replacement surgery. During your consultation, you’ll be given information about what you need to do in the days and weeks before your procedure, including whether you need to stop taking any of your regular medications and when you should stop eating and drinking ahead of surgery (as you’ll be having a general anaesthetic). It’s important that you follow all the instructions that you’re given, as this will help ensure everything goes as smoothly as possible on the day.

What to expect during robotic-assisted total knee replacement surgery

You can expect the day of your surgery for a robotic-assisted knee replacement to be very similar to one for a conventional knee replacement. The procedure is usually carried out under general anaesthetic, although in some cases a spinal block may be used instead. To minimise the risk of infection, you’ll be given antibiotics in the operating theatre just ahead of your surgery, and shortly afterwards.

Robotic-assisted knee replacement surgery can take slightly longer than the conventional technique. However, most people can expect their surgery to take between one and two hours.

MAKO® Robotic-Arm assisted surgery
Before your surgery, you will have a CT scan of your knee to create a 3D model of your knee joint. The 3D model is loaded into the MAKO® system software to create a personalised surgical plan, which your surgeon will use during your surgery. The plan includes the implant's exact size, placement, and alignment.

Your surgeon will cut the front of your knee to access the joint. They will then use the MAKO® robotic arm to remove the damaged cartilage and bone from your thigh bone (femur) and shin bone (tibia).

The artificial joint is then implanted. The robotic arm guides your surgeon to stay within the pre-planned boundaries set by the 3D model, allowing for accurate implant positioning. The implant is fixed to the bones using an acrylic cement or a special coating that allows the artificial joint to bond directly to the bone over time.

Your surgeon will check the new joint's stability, alignment, and movement before closing the cut with stitches or surgical clips and applying a padded dressing.

CORI® Surgical System
Your surgeon will use the CORI® system in the operating room to create a real-time 3D model of your knee. The 3D model is then used to create a personalised surgical plan, just like the MAKO® system.

Your surgeon will cut the front of your knee to access the joint, before using the handheld robotic-assisted tool to remove the damaged cartilage and bone from your thigh bone (femur) and shin bone (tibia). The CORI® system provides real-time feedback throughout the operation, helping your surgeon work more accurately.

The artificial joint is then implanted, and the rest of the procedure follows what is described in the MAKO® system above.

Recovery after robotic-assisted total knee replacement surgery

Whether you’ve opted for a conventional or robotic-assisted surgery, you can expect your recovery to take some time. While the incisions made to complete the surgery may heal in just a few weeks, you will need to be patient when it comes to bearing weight, moving around and getting back to your usual daily activities.

You can read more about what to expect from knee replacement surgery recovery here.

How soon can I go home after robotic-assisted total knee replacement surgery?

It really depends on how quickly you start to recover, but most people can expect to be allowed to go home between one and three days after their surgery. Your medical team will need to be confident that you can manage to move around safely, and that your pain is under control.

Do you spend less time in hospital with robotic-assisted total knee replacement compared to conventional surgery?

No. How long you stay in hospital depends on how well you recover from your surgery, and this varies from person to person.

How can I minimise recovery time after robotic-assisted knee replacement surgery?

It’s important to understand that knee replacement surgery will always come with a significant recovery period. However, there are some things that you can do to ensure that you get back on your feet as quickly as possible. These include:

• Consistent pain management. Make sure you take pain medications on the recommended schedule to keep your discomfort under control.
• Sticking to the physical therapy plan you’ll be given. This will be designed to get you mobile again, but in a safe, controlled way.
• Using your crutches, and any other aids, as advised by your medical team.
• Eating well and getting plenty of rest.

Top 5 mistakes to avoid after robotic-assisted knee replacement

1. Doing too much too soon. Total knee replacement is a major surgery, and it’s going to take time for you to recover. Rushing your recovery can cause setbacks that will ultimately mean it takes longer for you to get back to normal.
2. Trying to avoid taking painkillers. We know that many people don’t like to take pain medications, but you’ll struggle to do your physical therapy and manage day-to-day if your pain isn’t under control.
3. Not following your physiotherapy exercises. These form an essential part of your rehabilitation and should be completed as directed.
4. Failing to look after your wounds. Your incision will be dressed before you come home from hospital, but you’ll still need to keep it clean and dry while it heals.
5. Ignoring concerns. If something doesn’t seem right following your knee replacement surgery, always contact your medical team for advice.

What are the risks and complications of robotic-assisted total knee replacement?

The risks and complications associated with robotic-assisted total knee replacement surgery are largely the same as with traditional surgery. However, there are some potential additional risks that are unique to the robotic technique. These include a slightly longer operative time, damage to surrounding nerves and soft tissues, and pin-site issues⁷.

What is the success rate of robotic-assisted total knee replacement surgery?

Robotic-assisted total knee replacement surgery has very high success rates, with over 90% of people achieving significant improvement in their pain and joint function8. When it comes to longer-term results, studies show that after five years, success rates stand at around 80%⁹.

How much does a robotic-assisted total knee replacement cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.