The fundamental goal of both robotic and conventional knee replacement surgeries is the same: to reduce pain and improve function by replacing severely worn knee joint surfaces with prosthetic components. The key difference lies in the planning of the surgery and the way bone preparation is guided. In the Mako robotic system, a three-dimensional model is created from the patient’s CT images, the prosthesis position is planned on this model, and the surgeon performs bone preparation within haptic limits with the support of the robotic arm. In the conventional method, the surgeon uses anatomical references, mechanical guides, and intraoperative measurements.
In robotic knee replacement surgery, does the robot perform the operation?
No. Mako is not a robot that performs surgery autonomously.
Surgeon:
- The doctor determines if the patient is suitable for prosthetic surgery.
- It evaluates the three-dimensional surgical plan.
- He changes the plan during the surgery if necessary.
- He controls the robotic arm himself.
- It checks the bone preparation.
- He inserts the prosthesis.
- It assesses knee movement and ligament balance.
Robotic systems do not replace the surgeon’s decision-making process. They are a technology that assists the surgeon in implementing their plan using measurable data.
How is a traditional knee replacement performed?
Traditional total knee replacement surgery utilizes preoperative X-rays, a physical examination of the patient, and anatomical references during the operation.
Bone surfaces are typically prepared using mechanical or manual guides. The surgeon evaluates the size of the prosthesis, leg alignment, ligament balance, and implant placement during the operation.
Is Traditional Knee Replacement an Outdated or Failed Method?
No.
Traditional total knee replacement is a surgical procedure that has been performed for decades, and its long-term results have been extensively researched.
The development of robotic surgery does not mean that the traditional method is “wrong.” The main purpose of robotic systems is to make certain planning and execution phases more measurable and controllable.
How is 3D planning done in Mako Robotic Knee Replacement Surgery?
In the Mako system, a three-dimensional model of the patient’s knee is created from computed tomography images taken before surgery using a specific protocol.
The surgeon is using this model:
- The size and location of the femoral component,
- The size and location of the tibial component,
- The level of bone cuts,
- Leg alignment,
- When the knee is at different angles, the joint spaces,
- Soft tissue balance
can evaluate.
The plan can be updated by the surgeon as needed, based on data obtained during the operation.
What is Haptic Technology?
Mako’s AccuStop haptic technology helps the surgeon create a virtual and physical working boundary within a pre-defined bone preparation area.
The system may restrict robotic arm movement as the surgical instrument approaches outside the planned area.
What is the purpose of haptic technology?
The goal is not to “sideline” the surgeon’s intervention, but to support them in keeping the bone preparation within the planned schedule.
This feature:
- Implementation of the planned incisions,
- Helping to preserve healthy tissues,
- Controlled monitoring of the surgical plan.
It provides support in this regard.
Are Robotic Knee Replacement Technicians More Delicate?
Randomized controlled trials comparing robotic and manual total knee replacement have shown that robotic systems can provide an advantage in terms of accuracy in achieving planned limb alignment and implant position.
This is one of the strongest technical aspects of robotic knee surgery.
However, “more precise planning” is not the same as “better-feeling results for every patient.”
Technical accuracy:
- Pain,
- Function,
- Satisfaction,
- Long-term lifespan of the prosthesis
The extent of its effect will be assessed through separate clinical trials.
Is Robotic Knee Replacement Less Painful?
Some clinical studies have reported advantages in pain scores at certain periods after robotic knee replacement surgery.
A randomized controlled trial published in 2024 showed that the robot-assisted total knee replacement group experienced greater improvement in knee pain within the first year, but no clinically significant superiority was demonstrated in terms of function and health-related quality of life.
Because:
“Robotic knee replacement is completely painless” or “every patient experiences less pain.”
Statements that provide such guarantees are not scientifically accurate.
Does Robotic Knee Replacement Surgery Promote Faster Recovery?
While some studies report results favoring robotic techniques in early recovery, not all research shows the same outcome.
The rate of recovery does not depend solely on whether or not a robot is used.
The following factors are also important:
- Muscle strength before surgery
- Patient’s age
- Body weight
- Knee deformity
- Preoperative mobility
- Pain control
- Accompanying diseases
- Adaptation to rehabilitation
Robotic surgery is not a replacement for physical therapy or exercise.
What is the difference in terms of soft tissue balance?
In total knee replacement, simply preparing the bone surfaces is not enough. The balance of the ligaments on the inner and outer sides of the knee is also important.
The Mako Total Knee system can help measure joint spaces during surgery when the knee is at different angles, and to adjust the prosthetic plan based on this data.
This allows the surgeon to analyze joint balance not only through visual assessment but also with measurable data.
How are bone cuts made in robotic knee replacement surgery?
The surgeon operates the robotic arm himself.
Bone preparation:
1. 3D plan created before surgery, 2. Anatomical references recorded during surgery, 3. Implant plan determined by the surgeon, 4. Haptic working limits.
It is accomplished by using them together.
The robot does not initiate surgery on its own and does not make bone cuts without the surgeon’s control.
Are there any limitations to robotic surgery?
Yes. While robotic technology offers significant advantages, every technology has its limitations.
Need for Computed Tomography
CT imaging with an appropriate protocol is required for MAKO planning. This is an additional imaging step compared to the traditional method.
Cost and Access
Robotic systems have equipment, maintenance, consumables, and infrastructure costs. They may not be available in every hospital.
Surgeon’s Experience
The mere possession of a robotic device is not enough. The surgeon’s training and experience in both prosthetic surgery and the robotic platform used are crucial.
Long-term dominance is not guaranteed in every area.
Although there is strong data regarding the accuracy of implant placement with robotic systems, long-term comparative data are still being developed to definitively say that they provide better long-term function, satisfaction, or longer prosthesis life in all patients.
Who might be a suitable candidate for robotic knee replacement surgery?
Robotic technology is primarily considered for patients deemed suitable for knee replacement surgery.
Therefore, the first question is:
“Can I have robotic surgery?”
not,
“Do I really need knee replacement surgery?”
should be.
In patients with advanced knee osteoarthritis, replacement surgery may be considered in the following situations:
- Pain that significantly affects daily life.
- Significant reduction in walking distance.
- Night pain or pain at rest
- Significant limitation in knee movement.
- Deformity
- Symptoms that persist despite appropriate non-surgical treatments.
The decision is made based on examination and imaging.
Robotic or Traditional? How to Decide?
The correct method is not chosen solely based on the device name.
In the evaluation:
- Degree of calcification
- Leg alignment
- Bone structure
- The condition of the vineyards
- Previous surgeries
- The patient’s general health condition
- Patient expectations
- The surgeon’s experience
- The implant and technology to be used
They are considered together.
What is the main difference of Mako Robotic Knee Replacement?
Short answer:
Mako’s key difference lies in its ability to create a personalized surgical plan based on a 3D model generated from the patient’s CT images, and to allow the surgeon to perform bone preparation within haptic limits with the support of a robotic arm.
This system does not eliminate the surgeon; it technologically supports the surgeon’s planning and execution process.
Mako Robotic Knee Replacement in Adana
The Mako robotic surgical system is used at Private Adana Middle East Hospital. Op. Dr. Muhsin Dursun evaluates knee replacement candidates based on patient examination, imaging, level of osteoarthritis, and daily life expectations.
For detailed information about the Mako system and robotic surgery process, please see the pages “What is Robotic Knee Replacement” and “What is Mako Robotic Surgery?” .
Frequently Asked Questions
Is robotic knee replacement better than traditional methods?
Robotic systems can offer advantages in planning, alignment, and implant positioning accuracy. However, they do not guarantee better pain, function, or long-term results for every patient.
Can a robot make a bone cut on its own?
No. The surgeon controls the robotic arm and makes all the essential surgical decisions.
Why does Mako use CT scans?
A three-dimensional bone model of the patient is created from CT images, and the surgical plan is prepared on this model.
Is it possible that there will be no errors in robotic knee replacement surgery?
No surgical method offers zero risk or a 100% success guarantee. Robotic systems provide the surgeon with measurement and control support at specific technical stages.
Is traditional knee replacement surgery a failed method?
No. Traditional total knee replacement is a successful surgical method that has been used for many years and has strong long-term results.
Important Medical Information
This content is for general informational purposes only. The timelines and recommendations presented here are not the same for every patient; the type of surgery, the surgical approach used, comorbidities, preoperative muscle strength, and the physician’s rehabilitation protocol may all alter the process. Personal diagnosis, treatment, medication use, or postoperative activity decisions should be based on the recommendations of the orthopedic and traumatology specialist who is monitoring the patient.
