Robotic Knee Replacement Surgery

Robotic-assisted knee replacement surgery to support accurate implant positioning

Robotic knee replacement is a type of knee arthroplasty in which a robotic system assists the surgeon in planning and performing the procedure. The technology uses computer-aided mapping and a robotic arm to help guide surgical instruments with high precision. This process supports accurate removal of damaged bone and cartilage and assists in the positioning of the implant in line with your unique anatomy.

Compared to traditional methods, robotic-assisted techniques may improve implant alignment and soft tissue balance, which can support joint stability and long-term function. In some cases, this may also contribute to reduced post-operative pain and a quicker recovery.

Dr George Awwad offers robotic-assisted total and partial knee replacement surgery where appropriate. The approach is tailored using detailed imaging and planning software, and Dr Awwad will assess whether robotic technology is suitable for your needs during your consultation.

How robotic-assisted knee replacement works

Robotic-assisted knee replacement surgery combines a surgeon’s clinical expertise with advanced computer and robotic technology to help plan and execute the procedure with a high degree of accuracy.

Pre-operative planning

Before surgery, detailed imaging such as a CT scan is used to create a 3D model of your knee. This model allows the surgeon to carefully plan the size, position, and alignment of the implant components in advance, based on your individual anatomy and joint condition.

Intraoperative navigation

During the procedure, the robotic system provides real-time feedback to guide the surgeon in removing only the damaged bone and preserving healthy tissue. The robotic arm helps position the surgical instruments and implant components according to the preoperative plan, with fine-tuned precision that can adjust to soft tissue tension and joint balance.

Importantly, the robot does not perform the surgery on its own. Dr Awwad is in full control at all times and makes every surgical decision. The robotic system simply enhances the surgeon’s ability to work within millimetre-level accuracy, reducing variability and supporting consistent results.

Implant positioning

Accurate implant placement is critical to the success of knee replacement surgery. The robotic system assists in ensuring the implant fits the natural contours of your bone and is aligned properly to optimise movement and reduce stress on surrounding tissues.

By enhancing surgical planning and execution, robotic assistance may support a more personalised approach to joint replacement surgery, particularly in patients with complex anatomy or previous procedures.

Who may benefit from this technology

Robotic-assisted knee replacement may be suitable for a range of patients undergoing either total or partial knee replacement. It is designed to support greater accuracy and consistency in surgical technique, which may be particularly beneficial in certain situations.

Patients with early to moderate arthritis

Those with osteoarthritis confined to specific areas of the knee may be suitable for robotic-assisted partial knee replacement, where precision in implant sizing and positioning is especially important to preserve natural joint function.

Patients with complex anatomy or previous surgeries

Robotic technology can be helpful for patients who have unusual bone shapes, previous trauma, or anatomical changes from earlier procedures. The ability to plan surgery based on detailed 3D imaging may help reduce surgical challenges and improve implant alignment in these cases.

Active individuals and younger patients

For patients who lead active lifestyles, accurate implant positioning and soft tissue balancing utilising kinematic/functional alignment may help support smoother movement and potentially improve the longevity of the implant. Robotic assistance can help fine-tune alignment to suit individual anatomy, which may assist in maintaining more natural knee motion.

Patients seeking personalised care

Robotic-assisted technology allows for a more customised approach to knee replacement. If you are looking for a procedure tailored to your specific joint structure and soft tissue balance, this may be a helpful option. During your consultation, Dr Awwad will assess whether this approach aligns with your goals and clinical needs.

What to expect before, during, and after the procedure

Robotic-assisted knee replacement involves several stages, from detailed planning to surgery and post-operative recovery. Understanding what to expect at each step can help you prepare for the process and feel more confident about your care journey.

Pre-operative preparation and planning

Before surgery, you will have a comprehensive consultation with Dr George Awwad, where your symptoms, diagnosis, and imaging (such as X-rays or CT scans) will be reviewed. If robotic-assisted surgery is being considered, you may require additional preoperative CT imaging to create a 3D model of your knee joint.

This model is used in the robotic software to:

Dr Awwad will explain the procedure in detail and answer any questions you may have. You will also be given information about:

What happens during robotic-assisted knee replacement

On the day of your procedure, you will be admitted to hospital and meet your surgical and anaesthetic team. The procedure is performed in a fully equipped operating theatre under general or spinal anaesthesia.

Key steps of the procedure include:

Registration of the knee anatomy using robotic sensors and real-time tracking
Verification of the pre-operative plan, with the ability to make fine adjustments based on soft tissue balance
Robotic-guided bone resections to prepare the joint with sub-millimetre accuracy
Implant positioning and kinematic/functional alignment, based on your unique knee dynamics

The robotic system does not perform the surgery independently, Dr Awwad remains in full control at all times, using the robotic arm as a precision tool to guide instrument placement and ensure accuracy.

Recovery and rehabilitation after surgery

After surgery, you will be monitored in recovery before being transferred to your hospital room. Most patients stay in hospital for 2–3 days, depending on the type of knee replacement (total or partial), their medical history, and support at home.

Post-operative care includes:

You’ll be encouraged to start walking with the assistance of a frame or crutches on the same day or the day after surgery. Physiotherapy continues after discharge to help:

Dr Awwad will review your progress at scheduled follow-up appointments, and provide guidance on returning to work, driving, and sport or exercise based on your recovery.

What is the difference between robotic-assisted, conventional, and PSI techniques?

Knee replacement surgery can be performed using different methods, each with its own advantages. Dr Awwad selects the most appropriate technique for each patient based on their anatomy, condition, and goals.

Conventional Knee Replacement

In conventional total knee replacement, the surgeon uses standard surgical instruments and alignment guides during the procedure. This method relies on anatomical landmarks and experience to determine bone cuts and implant positioning. It has been used successfully for decades but may have limitations in precision, particularly in patients with abnormal anatomy or soft tissue imbalance.

Patient-Specific Instrumentation (PSI)

Patient-specific instrumentation (PSI) is a preoperative planning tool designed to enhance surgical accuracy by using customised cutting guides tailored to your individual knee anatomy. These guides are created using detailed imaging, typically MRI or CT scans, and provide a personalised approach to planning your knee replacement. By aligning the surgical plan with your unique bone structure, PSI aims to support more precise bone resections and implant positioning. The guides are manufactured before your surgery, which can also streamline certain aspects of the procedure and reduce time spent in the operating theatre.

PSI offers several advantages, including:

Custom-fit planning: The guides are built using your own imaging data to reflect the shape and alignment of your knee.
Improved efficiency: With detailed planning done in advance, PSI may support a more streamlined surgical process.
Enhanced precision: By guiding bone resections, PSI helps the surgeon place the implant in alignment with your preoperative plan.

While PSI does not dynamically adapt to soft tissue tension during the operation, your surgeon may still make intra-operative adjustments as needed to ensure optimal stability and function. In many cases, PSI can be combined with other technologies or techniques, such as computer navigation or robotic assistance, to provide a comprehensive and tailored surgical approach. Dr George Awwad uses a range of advanced planning tools, including patient-specific instrumentation, to personalise each knee replacement based on your condition, anatomy, and goals.

Robotic-Assisted Knee Replacement

Robotic-assisted surgery builds on the planning benefits of PSI and adds real-time intraoperative guidance. A robotic arm helps the surgeon make highly accurate bone cuts and fine-tune the position of the implant. Unlike PSI, robotic systems can respond to the patient’s actual soft tissue balance and anatomy during surgery, offering a more dynamic and personalised approach.

Comparing knee replacement technologies

Below is a general comparison of three commonly used surgical planning and execution methods in knee replacement: conventional techniques, patient-specific instrumentation (PSI), and robotic-assisted surgery. Each method offers distinct advantages, and Dr Awwad will recommend the most appropriate option based on your knee anatomy, condition, and goals.

Feature	Conventional Knee Replacement	Patient-Specific Instrumentation (PSI)	Robotic-Assisted Knee Replacement
Planning method	Standard pre-op X-rays and templating	MRI or CT scans used to create custom guides	Advanced imaging creates a 3D model of your knee
Customisation	Based on general anatomical averages	Cutting guides tailored to your unique bone structure	Personalised 3D mapping and live intra-operative adjustments
Technology used	Manual tools and surgeon experience	Pre-made guides for cutting and positioning	Robotic arm guided by surgeon in real-time
Intra-operative adjustment	Full flexibility during surgery	Limited; guides are pre-manufactured	Surgeon can adjust based on real-time feedback
Soft tissue balancing	Performed manually by the surgeon	Manual, based on fixed guides	Dynamically assessed during surgery
Surgical precision	Relies on surgeon’s visual alignment	Improved bone resection accuracy	Potential for sub-millimetre implant positioning accuracy
Hospital & equipment costs	Standard	May involve imaging costs (CT)	May involve imaging costs (CT)
Suitability	Widely used, suitable for many patients	Good option for straightforward cases with predictable anatomy	Ideal for patients who may benefit from enhanced alignment or complex joint anatomy

Which option is right for you?

Dr George Awwad will evaluate your condition, knee structure, and overall health to determine whether a conventional, PSI, or robotic-assisted approach is most appropriate for your surgery. In some cases, a combination of techniques may be used to personalise the procedure further.

Are there any drawbacks or risks with robotic-assisted surgery?

While robotic-assisted knee replacement offers benefits in terms of precision and planning, it’s important to understand that, like all surgical procedures, it also carries some risks and limitations. Being informed can help you make a confident, well-supported decision about your care.

Surgical risks remain similar to conventional techniques

The overall risks of robotic-assisted surgery are comparable to those of traditional knee replacement surgery. These include:

Infection
Blood clots (DVT or pulmonary embolism)
Bleeding or wound healing issues
Stiffness or reduced range of motion
Implant wear or loosening over time
Nerve or soft tissue injury (rare)

Dr Awwad will discuss these risks with you as part of the informed consent process, taking into account your overall health, joint condition, and medical history.

Technology-related considerations

Robotic technology supports accurate execution of the surgical plan, but it is not without considerations:

Not suitable for every patient: Robotic-assisted techniques may not be appropriate for all types of knee deformities or complex revision surgeries.
Preoperative imaging requirements: Some robotic systems require additional imaging, such as a CT scan, which involves a small radiation dose and may not be suitable for everyone.
Technology dependence: Although the robotic system is a tool under the surgeon’s control, there is a reliance on software and equipment functioning correctly on the day of surgery.
Slightly longer operating time: In some cases, robotic-assisted procedures may take slightly longer due to setup and planning stages.

Cost and insurance coverage considerations

Some patients may incur additional costs related to robotic-assisted procedures, such as preoperative imaging (CT scans).

Informed decision-making

Dr George Awwad will carefully assess your condition, anatomy, and personal goals to determine whether robotic assistance is appropriate in your case. The decision is always made in partnership with you, with a focus on achieving safe and effective outcomes tailored to your needs.

If you’re living with pain or stiffness that’s affecting your quality of life, a thorough assessment can help determine the cause and guide the right treatment path.