Robotic knee replacement uses computer-assisted technology to build a three-dimensional model of your knee, helping your surgeon plan implant positioning before any incision is made. A pre-operative CT scan and real-time intraoperative feedback support translating that plan accurately to your anatomy, while your surgeon maintains full control throughout.
This approach typically supports more consistent implant positioning, though individual outcomes still depend on your overall health, rehabilitation commitment, and the complexity of your knee condition.
Pre-Operative Assessment and Planning
Before scheduling surgery, your orthopaedic surgeon carries out a thorough evaluation to understand your anatomy and overall fitness for the procedure.
- Physical and medical review: A physical examination, X-rays, and detailed medical history review are combined with blood tests checking anaemia, kidney function, and clotting ability.
- Cardiac screening: An electrocardiogram assesses heart rhythm, and patients over 50 or with a cardiac history may need cardiology clearance.
- CT-based planning: A CT scan, taken one to two weeks before surgery and involving no contrast dye, captures detailed images of your femur, tibia, and patella, which software converts into a three-dimensional model used to plan implant size, positioning, and alignment.
Medical Optimisation Before Surgery
Getting your body ready for surgery can meaningfully influence how smoothly things go.
- Blood thinners such as warfarin typically stop five to seven days beforehand, while aspirin protocols vary by surgeon preference.
- Diabetes management often intensifies in the weeks before surgery, since elevated HbA1c levels are associated with higher infection risk.
- Smoking cessation at least four weeks prior may help, since smoking is known to impair wound healing and bone fusion.
Pre-operative physiotherapy, sometimes called “prehab,” strengthens the muscles around your knee and familiarises you with exercises you’ll continue after surgery.
The Week Before Surgery
Pre-admission typically happens three to seven days before your procedure, giving the care team time to prepare with you.
Pre-admission review: Nursing staff review your medications, allergies, and home situation, and provide fasting instructions, typically nothing to eat after midnight with clear fluids permitted until two hours before your scheduled time.
Preparing your home: Getting things ready in advance helps recovery go smoothly, clear walking paths, move frequently used items to waist height, and stock prepared meals.
Sleeping arrangements: If your bedroom is upstairs, setting up a temporary sleeping area on the ground floor for the first few weeks can make daily life easier.
What to Bring to Hospital
Pack loose-fitting clothes with elastic waistbands, supportive slip-on shoes with non-slip soles, your regular medications in original packaging, and something to occupy yourself during recovery. Leave valuables at home. Hospital stays for robotic knee replacement typically range from one to three days, and some patients qualify for same-day discharge depending on their medical status and home support.
Day of Surgery
Most patients arrive two to three hours before their scheduled procedure, where staff confirm identity, surgical site, and consent, and you’ll meet your anaesthetist to discuss options.
- Spinal anaesthesia numbs you from the waist down while you remain sedated. It’s used for most robotic knee replacements and is associated with reduced blood loss and post-operative nausea compared with general anaesthesia.
- General anaesthesia is used for some patients instead, based on medical factors or personal preference.
- IV access: An intravenous line is placed to provide fluid and medication access throughout the procedure.
During the Procedure
Your surgeon applies a tourniquet to temporarily reduce blood flow, then registers anatomical landmarks with the robotic system to correlate your actual anatomy with the pre-operative CT model.
- The robotic arm assists with bone preparation, guiding cuts according to the surgical plan, while boundaries built into the system help prevent deviation, though your surgeon remains in control throughout.
- Trial implants test fit and movement before your surgeon secures the final components.
- The procedure typically takes 60 to 90 minutes, and meta-analyses of robotic versus conventional technique suggest robotic assistance can add roughly 10 to 30 minutes compared with conventional technique, largely during the registration phase, though this gap narrows considerably for surgeons with high robotic case volumes.
Did You Know?
The robotic system creates a virtual boundary around the planned cutting area. If the saw approaches this boundary, the system provides resistance, which may help maintain precision even if your leg moves slightly during the procedure.
Immediate Post-Operative Period
Waking in the recovery room, nursing staff monitor your vital signs and pain levels as the anaesthesia wears off.
- Anaesthesia wearing off: Spinal anaesthesia typically wears off over two to four hours, during which you cannot move your legs, while a nerve block or local anaesthetic around the knee provides additional pain control lasting 12 to 24 hours.
- First steps: Most patients begin standing and walking within hours of surgery, often the same day, guided by a physiotherapist using a walking frame.
- Getting used to it: Initial walking can feel unfamiliar, since the new joint moves differently and surrounding muscles need time to regain coordination.
Pain Management
Pain typically peaks during the first 48 to 72 hours before gradually easing over the following weeks. Your medical team generally combines several types of medication, anti-inflammatories, targeted pain relief, and paracetamol for baseline comfort, along with ice and elevation, adjusting the approach based on how you respond.
Hospital Recovery Phase
Physiotherapy typically begins on the first day after surgery, starting gently and building from there.
Early exercises: Performed in bed, ankle pumps, quadriceps contractions, and gentle knee bending help improve circulation and begin restoring range of motion.
Building mobility: You’ll progress to sitting, standing, and walking as tolerated, working toward discharge criteria such as safe mobility with a walking aid and adequate pain control.
Wound care and warning signs: Nursing staff teach wound care and explain warning signs to watch for before you leave the hospital.
Most patients meet these functional benchmarks within one to three days, and discharge instructions typically include medication schedules, physiotherapy appointments, and a follow-up visit around two weeks later.
First Two Weeks at Home
This period centres on wound healing, swelling management, and settling into your exercise routine.
- Keep the incision clean and dry until cleared for showering, usually once staples or sutures are removed at the two-week mark.
- Apply ice for around 20 minutes several times daily to help manage swelling.
- Use your walking aid consistently, since attempting to walk unaided too early can increase fall risk and may delay recovery.
Important Note:
Contact your surgical team promptly if you notice increasing redness spreading from your incision, fever above 38 degrees Celsius, calf pain or swelling suggesting a blood clot, or wound drainage that worsens rather than improves.
Weeks Three Through Six
Physiotherapy intensity typically increases during this phase, with a focus on strengthening and balance.
Walking aids: Many patients transition from a walking frame to a single crutch or cane around week three or four, though this varies by individual progress.
Return to driving: Driving often resumes between four and six weeks, with right knee replacement patients typically waiting slightly longer due to braking requirements. Your surgeon provides specific clearance.
Daily activities: Light household tasks such as cooking, light cleaning, and desk work generally become manageable, while kneeling, squatting, and heavy lifting are best avoided during this stage.
Sleep disturbance can continue during this phase, and many patients find a pillow between the knees or pain medication before bed helps with rest quality.
Months Two Through Three
Most patients walk without assistive devices by eight to twelve weeks, with physiotherapy shifting toward functional activities.
Functional milestones: Climbing stairs foot over foot, getting in and out of cars smoothly, and rebuilding confidence in the knee’s stability become the main focus.
Swelling and warmth: Swelling resolves gradually but may persist for several months, and a knee that feels slightly warmer than the other side is a normal inflammatory response that typically settles by three to six months.
Returning to exercise: Low-impact activities such as stationary cycling, swimming, and water aerobics can resume, and many patients are comfortable walking several kilometres by three months.
Higher-impact activities generally need longer recovery and surgeon approval. Golf often resumes around three months, while hiking on uneven terrain may take four to six months, depending on your specific implant and recovery progress.
Long-Term Outcomes and Joint Care
Knee replacement implants generally function well for many years with appropriate care.
- Avoiding high-impact sports like running or jumping, maintaining a healthy weight, and continuing regular exercise all help protect your new joint over time.
- Annual follow-up appointments allow your surgeon to monitor implant function and detect concerns early, with X-rays showing implant positioning and identifying issues like loosening or wear.
- Reporting new pain, instability, or changes in function between scheduled appointments, rather than waiting, supports the best long-term outcome.
Quick Tip:
Inform all healthcare providers about your knee replacement before any dental procedures or surgeries. Current clinical guidance from orthopaedic and dental associations indicates that routine antibiotics before dental work are not generally needed for most patients, but your dentist and orthopaedic surgeon can advise if your specific situation warrants a different approach.
Setting Yourself Up for a Good Recovery
Realistic expectations tend to shape satisfaction with knee replacement as much as the surgery itself. The procedure is designed to reduce arthritic pain and improve function, though your new knee typically won’t feel identical to a natural, healthy joint, and some patients notice awareness of the implant or occasional clicking.
Commitment to physiotherapy also has a direct bearing on outcomes: patients who consistently attend sessions and perform their exercises generally achieve better range of motion and a faster return to activity.
In many ways, the effort invested in rehabilitation shapes the final result as much as the surgery itself.
When to Seek Professional Help
Contact your surgical team promptly if you notice:
- Fever above 38 degrees Celsius or chills suggesting infection
- Increasing redness, warmth, or drainage from your incision
- Sudden severe pain not relieved by prescribed medication
- Calf pain, swelling, or tenderness suggesting a blood clot
- Chest pain or shortness of breath, which needs immediate emergency care
- The knee giving way or feeling unstable during weight-bearing
- A significant decrease in range of motion after initial improvement
Commonly Asked Questions
How long does robotic knee replacement surgery take?
The procedure typically takes 60 to 90 minutes from incision to closure. Including anaesthesia preparation and positioning, expect to be in the operating theatre for around two hours. The robotic registration process adds modest time compared with conventional technique.
When can I shower after surgery?
Most surgeons allow showering once the incision has sealed and any staples or sutures are removed, typically at the two-week visit. Sponge baths keep the surgical site dry until then, and baths, pools, or hot tubs are generally avoided for at least four weeks.
Will I need a blood transfusion after robotic knee replacement?
Transfusion rates for robotic knee replacement are generally low. The tourniquet used during surgery helps minimise blood loss, and research comparing robotic-assisted and conventional techniques has generally found no significant difference in intraoperative blood loss between the two approaches.
How long will my knee replacement last?
Implant longevity depends on factors including your activity level, body weight, and implant type. Following activity guidelines and maintaining a healthy weight may help support implant lifespan, and regular follow-up appointments help detect any concerns early.
Can I kneel after knee replacement?
Kneeling is possible for many patients after full recovery, though it may feel uncomfortable, particularly if the incision area remains sensitive. Using a cushion or kneeling on the non-operated knee can help if kneeling is necessary.
Next Steps
Consistent physiotherapy is one of the most controllable factors in your recovery, and patients who complete prescribed exercises tend to achieve better range of motion and return to activities sooner.
Avoiding high-impact activities long-term, maintaining a healthy weight, and attending annual follow-up appointments all support implant longevity and help your surgeon catch early signs of loosening or wear.
If you’re experiencing persistent knee pain, stiffness that limits daily activities, or instability during weight-bearing, an accredited orthopaedic surgeon can help determine whether robotic knee replacement is a suitable option for your condition.
