Robotic surgery
Robotic knee replacement
Total and unicompartmental knee replacement with the active robotic system TSolution One®: personalised 3D planning, bone preparation with sub-millimetre accuracy and a rapid recovery protocol.
- Sub-millimetre accuracy
- Walking the same day
- Discharge in 1–2 days
What is active robotic joint replacement
Our surgical team performs knee replacement with the active robotic system TSolution One® by Think Surgical (USA), one of the most advanced technologies in the field of joint replacement.
Drawing on our knowledge and experience, we plan the operation in complete detail in the TPLAN® software. The robot then carries out, based on our instructions and under our continuous supervision, the most critical part of the procedure: preparing the bone for the implants.
“Our mind does not allow the robot to make a mistake. The robot does not allow our hand to make a mistake.”— Marios G. Salmas
How TSolution One® works
The system combines two technologies: TPLAN®, a 3D pre-operative planning workstation, and TCAT®, a computer-guided robotic tool.
- CT scanA 3D model of the patient’s knee is created from the CT data.
- Planning in TPLAN®The surgeon positions the implants virtually, taking into account the axes, the individual anatomy and the clinical picture.
- Execution with TCAT®The robot prepares the bone with sub-millimetre accuracy, so that the implants are placed exactly according to the plan.
Active robotic system: what is the difference
Not all robotic systems work in the same way. Semi-active systems, such as MAKO, use navigation to keep the surgeon’s movements within a permitted range. TSolution One® is an active system: it carries out the surgeon’s own pre-operative plan, preparing the bone automatically.
That is why we chose this system for knee replacements. The system is cleared by the US FDA for knee and hip procedures, and its technology has been used in thousands of joint replacements worldwide.
Why robotic rather than conventional joint replacement
After a conventional total knee replacement, a proportion of patients are not fully satisfied or develop pain or stiffness over time. Accurate implant positioning has been shown to reduce post-operative problems, contribute to the longevity of the replacement and lower the risk of early loosening that would lead to a repeat operation (revision).
Studies on TSolution One® show improved fit, positioning and alignment of the implants compared with the conventional technique.
Advantages of robotic knee replacement
- The surgeon chooses the most suitable implant
- Precise 3D pre-operative planning
- Surgical accuracy to tenths of a millimetre
- Bone milling instead of a saw for the bone cuts
- Minimal blood loss
- Small incisions
- Rapid recovery with the Fast-Track protocol
- Greater longevity of the replacement
Which patients is it suitable for
Robotic knee replacement is the definitive treatment for advanced osteoarthritis of the knee, when pain and stiffness no longer respond to conservative treatment (physiotherapy, medication, injections).
Depending on the extent of the wear, either a total knee replacement, in which all the joint surfaces are replaced, or a unicompartmental (partial) knee replacement, when the damage is limited to one part of the knee, may be performed. Careful diagnosis is needed before the operation to rule out other conditions, such as osteonecrosis of the knee.
Read more about the condition: Knee osteoarthritis: symptoms, diagnosis and treatments →
The surgeon’s experience
Correct patient selection, together with careful review and final approval of the pre-operative plan, is decisive for the outcome. If the surgeon plans correctly, the robot will execute accurately; that is why robotic technology always relies on the doctor’s knowledge and judgement.
Our team has performed more than 2,000 knee and hip replacements since 1998 and continues to follow up patients who were operated on more than 20 years ago, with very good results.
Everything you need to know about total knee replacement
How the operation is performed
- AnaesthesiaThe anaesthetist examines the patient before the operation and recommends the most suitable method. Spinal or regional anaesthesia is usually preferred, combined with ultrasound-guided blocks of the knee nerves, which provide very good pain relief and allow mobilisation a few hours later.
- Incision without cutting the quadricepsThe incision is made on the front of the knee and is small (6–8 cm, compared with 20–25 cm in the past). Our team does not cut the quadriceps tendon, which means less pain, more strength and faster recovery.
- Robotic bone preparationThe osteophytes and worn cartilage are removed, and the robot shapes the femur and tibia exactly according to the plan. A trial prosthesis is fitted to check movement and ligament balance.
- Implant placementThe metal components of the prosthesis are fixed to the femur and tibia, with a durable polyethylene insert between them for smooth gliding.
- Wound closureAbsorbable sutures or an intradermal suture are used, which do not need to be removed. Drains are rarely required.
Recovery with the Fast-Track protocol
The Fast-Track rapid recovery protocol (Enhanced Recovery After Surgery – ERAS) combines modern pre-operative preparation, a dedicated anaesthesia protocol and a minimally traumatic surgical technique. The aim is less pain, less bleeding and a quick return to everyday life.
- Immediate weight-bearing from the day of surgery
- Minimal post-operative pain
- No catheters or drains in most patients
- Blood transfusion rarely needed
- Fewer days in hospital
- Fewer physiotherapy sessions
What to expect after the operation
- Day of surgeryWalking with the help of a walking frame a few hours after the operation.
- 1st post-operative dayWalking unaided, going up and down stairs, full range of motion of the knee.
- Day 1–2Discharge from hospital. Under the right conditions, a day-case stay is also possible.
- First weeksAbout 5 physiotherapy sessions at home.
- 2 weeksRemoval of the stitches, unless an intradermal suture was used.
Marios Salmas on robotic knee replacement on the TV programme “Ygeia pano ap’ ola” (Health above all)
The doctor will examine your case and recommend the right treatment.
Request an appointment210 7793103Frequently asked questions
Robotic knee replacement: frequently asked questions
Didn’t find the answer you were looking for? Call us on 210 7793103.
How long does the operation take?
The operation usually takes 55–60 minutes. Preparation and recovery from anaesthesia are added to this time. A longer duration does not mean there is a problem, as it depends on the particular features of each case.
When will I walk after the knee replacement?
On the same day as the operation, with the help of a walking frame. The next day, most patients walk unaided and climb stairs.
How many days will I stay in hospital?
Usually 1–2 days. With the Fast-Track protocol and under the right conditions, discharge is possible even on the same day.
Will I need a blood transfusion?
Most patients do not. Minimally invasive techniques and the administration of tranexamic acid significantly reduce bleeding. A transfusion is needed only in rare cases.
What kind of anaesthesia is used?
Usually spinal or regional anaesthesia, combined with ultrasound-guided blocks of the knee nerves. The final choice is made by the anaesthetist, in consultation with the patient.
How do I prepare for the operation?
Good physical condition, strong muscles and a reasonable body weight contribute to a faster recovery. Before the operation, any other active infection (e.g. of the skin or teeth) must be ruled out.
How many physiotherapy sessions will I need?
About 5 sessions at home. Thanks to the robotic technique and the fact that the quadriceps tendon is not cut, some patients need even fewer.
Can both knees be replaced at the same time?
Yes. In suitable patients, both knees are replaced at the same time, with one anaesthetic and one recovery period. Read more.
Patient cases
Patients after knee replacement
3 hours after hybrid robotic knee replacement with the Fast-Track protocol
Robotic total knee replacement without physiotherapy
Total knee replacement – 1 day after surgery
Total knee replacement – 2 days after surgery
Total knee replacement – 3rd day after surgery
Hybrid total knee replacement
Patient testimonials
What our patients say
“After months of difficulty walking and unbearable pain in both knees, I had robotic replacement of both knees. Three hours after the operation I got up and walked with a walking aid, without any pain. The next day I felt ready to walk without any help at all.”
“My mother had a robotic knee replacement. She was up and moving almost four hours after the operation, and on the third day she walked on her own. We thank the doctor for his constant support and for the sense of safety he gave us.”
“My mother’s operation went extremely well, painlessly and with immediate mobilisation, without any ordeal, drains or a long hospital stay. The constant contact with the patient and her family was genuinely meaningful and very helpful.”
Appointment
Does your knee hurt?
Book an appointment for an assessment. The doctor will examine your case and explain whether robotic knee replacement is the right solution for you.