KNEE SURGERY

Robotic-assisted knee replacement

Robotics is at the heart of innovation in many fields, including surgery. 
Robotic assistance in surgery has developed considerably over the last 30 years in many specialities: urological surgery (Vinci robot), ENT and ophthalmological surgery, neurosurgery, thoracic and visceral surgery, and of course orthopaedic surgery.

The fitting of a knee prosthesis is no exception to this rule. For some, robotics represents a major technological advance in this field. 
There is no doubt that it improves the precision of the surgical procedure during the fitting of a knee prosthesis (total or partial).  
Robotics in the field of knee prosthesis should ultimately be understood as an ancillary (the instrumental system used to position a prosthesis) of the latest generation.


knee picto

What is robotic assistance?
in knee surgery?

It is important to understand that robotic surgery is one of the latest steps in the continuous improvement and development of knee replacement techniques over the last 30 years. 

These include navigation systems, customised cutting guides, robotics without imaging coupling (VELYS, ROSA, ApolloKnee, etc.) and robotics coupled with scanner imaging (MAKO). The subject of custom knee prostheses has been developed on another page of our website.

This is not "automatic" surgery: the robot does not operate in the surgeon's place. The aim is to a tool (the robotic arm), which provides the surgeon with precision and safety. It is a real aid to performing the procedure, perfectly calibrated and guided by dynamic 3-D digital planning.

The installation of a knee prosthesis, whether total or partial, with robotic assistance will follow the following steps (with the robot coupled to scanner imaging, here we give the explanations with the MAKO robot, Stryker):

  • Making it happen a knee scan. To take account of the entire skeleton of the operated leg, the scanner also analyses the centre of the hip and the centre of the ankle. This makes it possible to assess the overall deformity of the lower limb in all three spatial dimensions.
  • A preoperative 3D modelling of your knee from this scanner using special software. 
  • Planning made-to-measure: this modelling enables the biomechanical engineer to plan the operation. This planning takes into account the patient's specific anatomy, the deformity of the leg and the corrections to be made. It defines the ideal size and position of the prosthesis (of the femur and tibia implants. This planning is validated by the surgeon.
  • All the data is then transferred to the robot software so that he can assist the surgeon during the operation.
  • At the beginning of the operation, the surgeon will perform a link between 3D image reconstruction and the patient's knee with a coupling accuracy of between 0.1 and 0.5 mm.
  • During the operation, the robotic arm is used to make the bone cuts while the bone is being removed.
    respecting the noble structures: vessels and ligaments.
mako total knee application
mako tka digital pre-planning

What are the benefits of robot-assisted surgery?

The use of robotics coupled with imaging enables :

  • Greater precision and safety in the positioning of the prosthesis
  • A control of ligament laxity during the operation, as the robot continuously provides the surgeon with ligament tension values. It provides dynamic information (like navigation), which is not the case, for example, with a custom-made prosthesis.
  • According to some publications, robotics would reduce post-operative pain and enable faster functional recovery. This is still debated and cannot be taken for granted.
  • A working comfort for the surgeon (less effort, more feedback, less need to spread muscles and ligaments).

Who can benefit from robotic assistance?

It is used for :

  • The total knee prostheses
  • The partial knee replacements (unicompartmental)
  • And more recently for revision knee replacements

Robotic knee replacement surgery can be offered to all patients. There are no particular restrictions in terms of age or level of activity.

The only limit may be very poor bone quality in the tibia. The installation of a knee prosthesis with robotic assistance requires the following during the operation fitting sensor pins to the tibia so that the robot can constantly track the position of the leg. The same applies to any navigation system. If the patient has a very fragile tibia, care must be taken to avoid encouraging a tibia fracture. In this case, it is better to use a conventional ancillary system without pins.

020 ligament balancing
008 ct landmarks1

What is the procedure with the robot?

In principle, the operation is carried out in exactly the same way as a conventional knee prosthesis: the knee is approached, the bone is cut, the implants are placed and the prosthesis is closed. There are, of course, a few special features.

  • The surgeon approaches the knee joint using a conventional approach
  • It positions pins with tracking sensors on the femur and tibia. It is these sensors that will inform the robot throughout the operation of the position of the patient's femur and tibia.
  • The surgeon performs coupling between the patient's joint and the robot's 3D imaging reconstruction
  • Finally, the parameters ligament laxity of the knee are recorded: medial and lateral
  • The surgeon will refine, then validate planning carried out before the operation. The robot guides him through this stage using all the information transmitted by the sensors
  • The bone sections are performed with the robotic arm. The robot automatically stops flush with the bone to avoid soft tissue (ligaments, vessels, etc.). 
  • The surgeon can then position the implants of the prosthesis and control in real time with the robot that planning has been respected

The procedure lasts on average between 60 to 90 minutes. 

Recovery and post-operative care

Robotic-assisted surgery does not fundamentally alter the post-operative protocolHowever, some publications report that it facilitates recovery (pain and mobility) in the early phase. The literature is contradictory on the subject. We must not think that robotic surgery makes the post-operative period "simple" and "painless" .... The post-operative period following a knee replacement remains long, and pain is a factor to be taken into account.

For some surgeons, robotic surgery has become indispensable and represents a real advance. For others, it's just another piece of equipment that isn't essential.

009 resection landmarks

Where to have an operation in Paris?

Our teams work in a number of leading establishments in Paris:

For consultations:

  • Espace Médical Vauban
  • IMSS - Institut Médical Sport Santé
  • ARAGO Clinic

For interventions:

  • ARAGO Clinic

You will be cared for by recognised specialists: Dr Kerboull, Dr Sailhan and Dr Zilber, experts in hip surgery.

clinical entrance

Robotic-assisted knee surgery means that the operation can be tailored to the anatomical and dynamic (ligament) parameters of the patient's knee.

Would you like to know whether you could benefit from a robot-assisted prosthesis? Contact our specialist team for personalised advice.

Contact us for a consultation

Frequently asked questions (FAQ)

Is robotic surgery reimbursed?

Yes, the procedure is covered by social security.

Is it safer than conventional surgery?

Yes, insofar as the robot interrupts the bone cuts as soon as the blade goes beyond the limits of the bone to protect the vessels and ligaments.

Can I request a robot-assisted prosthesis?

You should discuss this point with your surgeon. The important thing is not the technique used, but the surgeon's mastery of it.