Traditional vs robotic knee surgery

There is no difference in the long-term success rate of both surgical procedures

Dr Ravi Gupta

Updated At : 05:14 AM Jun 21, 2025 IST

Traditional surgery has a proven success rate of around five decades, and is less costly. Istock

Total knee replacement (TKR) surgery has transformed the life of thousands of patients worldwide who have experienced painful knee joints. It involves replacing the worn-out joint surfaces with metallic components that have an intervening plastic insert.

The following facts are important when one decides to undergo TKR surgery:

Material of implant

When choosing a femoral component for TKR, three types of materials are commonly used — traditional cobalt-chromium (CoCr) alloy, oxinium (oxidised zirconium) and gold-coated implants.

Traditional cobalt-chromium (CoCr): It is an alloy of cobalt, chromium, and molybdenum. A time-tested and the most economical option, the CoCr is being used for decades and has a good track record. However, it contains nickel, and in rare cases causes adverse reactions in patients allergic to these metals. However, this implant remains the gold standard for most patients due to its robust history and cost-effectiveness. But it is not ideal for allergy-prone and/or highly active younger patients.

Oxinium (Oxidised zirconium): This material has zirconium metal with a ceramic oxide surface layer, which provides toughness and enhanced wear resistance to the femoral component that enhances the life of the artificial knee joint. This material is suitable for those allergic to metal(s). However, it is significantly more expensive and relatively brittle, hence it is prone to fractures. Oxinium is more suitable for relatively younger patients and those with a history of allergy to metals.

Gold-coated femoral components with titanium nitride coating: This implant has a surface coating of titanium nitride applied to the traditional CoCr components. The golden colour comes from the coating and no actual gold is used. This makes the implant highly inert and is useful for patients with metal allergies. Due to enhanced wear resistance of the surface, the life of this implant is thought to be longer. It is more expensive than the traditional CoCr but cheaper than the oxinium.

Total knee replacement surgery involves replacing the worn-out joint surfaces with metallic components that have an intervening plastic insert.

Apart from these, patient-specific instrumentation and implants are also available, customised to individual needs. With the help of 3D printing, patient-specific implants and cutting guides are created, potentially improving the fit and performance of the implant. But, as of today, no significant superiority of this technology has been observed over the traditional method while the cost of the procedure becomes exponentially high.

Comparative analysis

Traditional TKR surgery has a proven track record of success of around five decades with established reliability, affordability, and long-standing success. Long-term studies show implant survival in over 90 per cent cases for 15 to 20 years. The average duration of surgery is around 60 minutes.

In recent years, robotic surgery has been gaining popularity. The advantages of the robotic TKR are reported to be superior component alignment, better soft tissue balancing, relatively lesser blood loss and potentially faster recovery with reduced pain. The challenges, however, include high cost, longer operative time (around 20-30 minutes longer) and a steep learning curve for the surgeon and operation theatre staff.

The most important factor for selecting between the robotic versus conventional TKR, as of now, should be based on the experience and expertise of the operating surgeon (robotic or traditional), because the long-term clinical and functional outcomes, as well as complication rates, have been reported to be similar between the two.

Pain management

The modern anaesthesia and post-operative pain management strategies have reduced the hospital stays and improved early mobility after TKR surgery. However, some recent studies have reported even shorter hospital stay with robotic TKR. All patients of both robotic or traditional TKR begin walking within 24 hours of surgery and become self-dependent in 2-4 days.

Complications

Infection: It is a serious complication, and if it happens, it often requires surgical debridement, implant removal, or revision surgery.

Deep vein thrombosis (DVT): In DVT, blood clots can form in the veins of legs. It should be recognised and treated early to prevent the potentially fatal rare complication of pulmonary embolism (PE) when the clots from the legs move to the lungs. Use of blood thinners and early mobilisation reduce this risk.

Bleeding and hematoma: It means clotting can happen due to trauma or injury, which can cause pain and delay in wound healing.

Neurovascular Injury: Injury to nerve and vessel during the surgery can cause serious complications but such injury is rare.

Dissatisfied patients

Up to 20 per cent patients undergoing knee replacement surgery are reported to be dissatisfied although the surgical implantation of the joint is correct. These patients are dissatisfied due to persistent pain, unacceptable stiffness, or functional limitations.

TKR is a highly successful procedure when performed in a patient whose knee pain is disabling the patient from performing activities of daily living. Both the surgeon as well as the patient should have a thorough understanding of the various designs and materials of the implant components.

A good knowledge of the potential risk factors and the complications on the part of the surgeon is essential for risk mitigation, early detection, and effective management. Pre-operative optimisation of the risk factors, meticulous surgical technique, and proper rehabilitation are key to minimising risks.

— The writer is Chairman, Orthopaedics, Paras Hospital, Panchkula

Risk factors for complications

Obesity

Diabetes

Smoking

Rheumatoid arthritis

Prior knee surgeries

Poor nutrition

Immunosuppression

Traditional vs robotic knee surgery

Dr Ravi Gupta

Unlock Exclusive Insights with The Tribune Premium

Live Matches