Robotic Knee Replacement Surgery
The word robotic causes more confusion in this procedure than any other term in orthopedics. No robot performs a knee replacement. What the technology provides is a surgical plan built from a scan of your specific knee and a boundary that keeps the cutting instrument inside that plan, with the surgeon controlling the arm throughout.
Steven Struhl, MD trained in engineering at the Massachusetts Institute of Technology before earning his medical degree at the University of California, San Francisco, which is an unusual background for an orthopedic surgeon and a useful one here. He is board certified in orthopedic surgery and separately in sports medicine, is a Fellow of the American Academy of Orthopaedic Surgeons, and holds a United States patent for an orthopedic reconstruction device. He performs robotic assisted partial and total knee replacement in Manhattan and White Plains.
How Robotic Assisted Knee Surgery Works
The process begins before the day of surgery.
- Preoperative CT Scan: a scan of your knee is used to build a three dimensional model specific to your anatomy.
- Surgical Planning: implant size, position, and alignment are determined on that model in advance rather than worked out in the operating room.
- Intraoperative Adjustment: once the knee is open and soft tissue tension can be assessed directly, the plan is refined.
- Defined Boundaries: the system constrains the cutting instrument to the area established in the plan.
- Continuous Feedback: the surgeon receives visual and audible information throughout bone preparation.
- Surgeon Control Throughout: the robotic arm does not move independently, make decisions, or operate on its own.
MAKOplasty Partial Knee Resurfacing
The MAKOplasty procedure treats arthritis confined to a single compartment of the knee, most often the inner side, leaving the healthy compartments and both cruciate ligaments alone. It uses the RIO Robotic Arm Interactive Orthopedic System, with the CT based plan described above and RESTORIS implants seated within it.
Partial resurfacing suits early to middle stage arthritis where the damage has not spread across the joint. It is the same operation described on the partial knee replacement page, performed with robotic assistance rather than with conventional instrumentation.
What Robotic Assistance Changes and What It Does Not
Being clear about this is more useful than overstating it.
- Implant Position: the clearest documented benefit, with studies consistently showing more precise and more reproducible component placement than conventional instrumentation.
- Soft Tissue Balance: the plan can be adjusted intraoperatively based on measured tension rather than on feel alone.
- Early Pain: several studies report less pain in the early weeks after robotic assisted partial knee replacement.
- Long Term Survival: whether improved positioning translates into longer implant life is a question the evidence is still answering, since the technology has not been in use long enough for twenty year results.
- The Operation Itself: the procedure, the implants, and the recovery are the knee replacement they have always been. The planning and the precision of execution are what the technology changes.
Component position is known to influence how a knee feels and how long it lasts, which is the reasoning behind the approach. That is a sound reason to use it and it is not a guarantee of outcome.
Recovery After Robotic Knee Replacement
Recovery follows the procedure performed rather than the technology used. A partial knee replacement, robotic or conventional, recovers faster than a total replacement because it is a smaller operation on a knee that keeps most of its own structures.
- Day of Surgery: weight bearing begins immediately in most cases.
- Weeks One to Three: walking without support for many partial knee patients, with therapy focused on motion and quadriceps activation.
- Weeks Four to Eight: return to driving, desk work, and most daily activity.
- Months Two to Six: strength rebuilding and return to walking, cycling, golf, and similar activity.
Frequently Asked Questions About Robotic Knee Replacement
Does a robot perform my knee replacement?
No, and the name causes this confusion routinely. The surgeon performs the operation and controls the robotic arm throughout. The system does not move on its own, make decisions, or operate independently. What it provides is a plan built from a CT scan of your specific knee and a boundary that constrains the cutting instrument to the area defined in that plan, along with continuous feedback during bone preparation. The surgeon’s judgment determines the plan and the surgeon’s hands execute it.
What does the CT scan before surgery do?
It builds a three dimensional model of your knee that is specific to your anatomy, and the surgical plan is made on that model before the day of surgery rather than being worked out in the operating room. Implant size, position, and alignment are all determined in advance and can then be adjusted during the procedure once the knee is open and soft tissue balance can be assessed directly. The scan is a straightforward outpatient study and is not uncomfortable.
Is robotic knee replacement better than conventional knee replacement?
The clearest documented advantage is accuracy of implant placement, and studies consistently show robotic assisted positioning is more precise and more reproducible than conventional instrumentation. Whether that translates into longer implant survival is a question the long term data is still answering, since the technology has not been in use long enough for twenty year results. Component position is known to influence how a knee feels and how long it lasts, which is the reasoning behind the approach, and it is worth being clear about what is established and what is still being studied.
Which patients are candidates for MAKOplasty partial knee resurfacing?
The same patients who are candidates for partial knee replacement generally, meaning arthritis confined to one compartment with the remaining compartments healthy, reasonable alignment, intact ligaments, and a knee that still moves well. Arthritis across multiple compartments, inflammatory arthritis such as rheumatoid disease, significant deformity, and instability all point toward total knee replacement instead. Candidacy is determined by examination and imaging, and the CT scan confirms it.
Is recovery faster after robotic knee replacement?
Recovery after a partial knee replacement is generally faster than after a total replacement, and that difference comes mainly from the smaller operation rather than from the robot. Patients treated with robotic assistance frequently report less early pain, which several studies support. What robotic assistance most reliably changes is the accuracy of the implant position, and the recovery advantages that follow from a smaller procedure apply to partial knee replacement whether it is performed robotically or conventionally.
Is robotic knee replacement covered by insurance?
Robotic assisted knee replacement is generally treated as knee replacement surgery for coverage purposes, and it is typically covered by Medicare and by private insurers on the same basis as conventional replacement. Coverage still depends on your specific plan, on documentation that nonsurgical treatment has been tried, and in many cases on prior authorization. Our office verifies benefits before scheduling, and that is the reliable answer rather than any general statement about coverage.
Schedule a Robotic Knee Consultation in New York City
The first question worth answering is not whether to use robotic assistance, it is which operation your knee actually needs, since a partial replacement and a total replacement suit very different knees. That question is settled by examination and imaging. Dr. Struhl evaluates knee replacement candidates at his Manhattan and White Plains offices. Contact Dr. Struhl to schedule a consultation.