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Robotic Total Knee Arthroplasty (TKA) — Advanced Navigation

CT- or imageless-based haptic robotic platforms (MAKO, ROSA, NAVIO/CORI, VELYS) for total knee replacement that combine 3D pre-operative planning, intra-operative dynamic gap balancing, and robotic-assisted bone resection with sub-millimeter precision and improved component alignment.

Written by: Saygı Hospital Health Guide Editorial Board
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This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Robotic Total Knee Arthroplasty (TKA) — Advanced Navigation?

Robotic total knee arthroplasty (RA-TKA) is the integration of robotic-assisted technologies into knee replacement surgery to enhance surgical precision, component positioning, soft-tissue balancing, and reproducibility. Major commercial platforms include MAKO (Stryker — semi-active CT-based), ROSA Knee (Zimmer Biomet — imageless or X-ray planning), NAVIO/CORI (Smith & Nephew — handheld imageless), and VELYS (DePuy Synthes — imageless), each offering CT or imageless workflows.

These systems share a common workflow: pre-operative or intra-operative anatomic mapping → 3D virtual implant planning (size, position, alignment) → dynamic intra-operative gap balancing through trial articulation → robotic-assisted or robot-guided bone resection (haptic boundary, autonomous, or saw guide). The goal is to achieve target alignment (mechanical, kinematic, or functional alignment), balanced flexion-extension gaps, and stable patellar tracking with sub-millimeter and sub-degree accuracy.

Evidence shows RA-TKA improves component alignment accuracy and reduces outliers > 3° from target compared with conventional TKA; soft-tissue balance is more reproducible. Recent RCTs (e.g., MAKO, ROSA, VELYS) demonstrate small but statistically significant short-term advantages in pain, function (KOOS, OKS), reduced narcotic use, and shorter hospital stay; however, 5- and 10-year revision rates and patient-reported outcomes (PROMs) remain to be definitively established. Limitations include capital cost, disposables, longer operative time (10–25 min), surgeon learning curve, and dependence on accurate registration.

Symptoms

End-stage knee osteoarthritis with bone-on-bone contact
Severe pain unrelieved by conservative therapy (≥ 3–6 months)
Functional limitation in walking, stair climbing, transfers
Failed unicompartmental arthroplasty or osteotomy
Post-traumatic or inflammatory arthritis (RA, PsA, gout)
Avascular necrosis with subchondral collapse
Severe varus / valgus deformity, flexion contracture (relative indications for robotic precision)

Risk Factors

Severe deformity (> 15° varus or valgus, > 15° flexion contracture)
Obesity (BMI > 35) — increased surgical complexity
Prior knee surgery, periarticular hardware, osteotomy
Bone loss (Anderson Orthopaedic Research Institute classification)
Patellofemoral maltracking
Concurrent ligament instability
Patient comorbidities affecting surgical candidacy (diabetes, vascular)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent knee pain unrelieved by NSAIDs, injections, weight loss, physical therapy
  • Difficulty walking > 1 block, climbing stairs, or rising from chair
  • Severe deformity (bowed leg, knock-knee) interfering with function
  • Recurrent locking, swelling, or instability
  • Failure of conservative therapy after 3–6 months
  • Loss of independence due to knee pain or limited mobility
  • Prior failed knee surgery (osteotomy, unicompartmental, ligament reconstruction)

Treatment Methods

01
Pre-op assessment: standing long-leg radiographs, lateral, sunrise, and CT (for MAKO) or imageless registration (ROSA, VELYS, NAVIO/CORI)
02
Robotic-assisted TKA: choose platform (MAKO Stryker, ROSA Zimmer Biomet, VELYS DePuy Synthes, NAVIO/CORI Smith & Nephew) based on surgeon preference, hospital infrastructure, and implant ecosystem
03
Intra-operative: anatomic registration → virtual 3D plan → dynamic gap balancing through trial range of motion → haptic-guided bone resection → cementless or cemented final implant
04
Targets: mechanical / kinematic / functional alignment within ± 1° of plan, gap balance ± 1 mm flexion vs extension, patellar tracking optimization
05
Post-op: enhanced recovery after surgery (ERAS) protocol, early mobilization day 0, multimodal analgesia (peripheral nerve block, periarticular injection, oral NSAIDs, low-dose opioids), DVT prophylaxis, physical therapy
06
Outcome monitoring: Knee Society Score, KOOS, OKS at 6 weeks, 6 months, 1 year, 2 years; serial radiographs to monitor implant position and aseptic loosening
07
Discuss with patient: cost vs. benefit, lack of long-term superiority data, learning curve, and conventional TKA as proven alternative with > 95% 15-year survival

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.