Robotic Total Knee Replacement Walk-Through with Cory Calendine, MD, Orthopedic Surgeon
If you’re considering knee replacement surgery, you probably have questions about how the procedure actually works — and whether robotic technology makes a real difference. As a fellowship-trained orthopedic surgeon who performs over 700 hip and knee replacements a year using the Mako robotic system, I want to walk you through exactly what Mako robotic knee replacement involves, step by step.
This isn’t a sales pitch. It’s an honest explanation of the technology I use on every primary knee replacement I perform at the Bone and Joint Institute of Tennessee in Franklin, TN — and why I believe it matters for your outcome.
What Is Mako Robotic Knee Replacement?
Mako robotic-assisted surgery is a technology developed by Stryker that gives your orthopedic surgeon two things manual technique alone can’t consistently provide: a detailed 3D plan built from your own anatomy, and real-time robotic guidance in the operating room to execute that plan precisely.
The Mako system uses a pre-operative CT scan to create a three-dimensional virtual model of your knee. That model captures your bone geometry, alignment, and joint line — details that are unique to you. Using this model, I plan implant size, position, and rotation before you ever arrive at the hospital.
In the operating room, the robotic arm provides haptic feedback — a physical resistance — that keeps bone preparation within the boundaries of the surgical plan. The robotic arm doesn’t operate on its own. It doesn’t make decisions. I’m in complete control at every moment. Mako is a precision tool that helps me do what I’ve trained to do — more accurately and more consistently.
How Mako Robotic-Assisted Total Knee Replacement Surgery Works
Step 1: Pre-Operative CT Scan and 3D Planning
Before your surgery date, a CT scan of your knee is taken. This scan generates a precise three-dimensional digital model of your anatomy — not a generic template, but your actual bone structure, alignment, and geometry.
I use that model to plan the entire procedure in advance. Implant size, component position, and alignment are all determined based on your specific anatomy. This planning step is where the precision of Mako robotic knee replacement begins.
Step 2: Intraoperative Robotic Guidance
On the day of surgery, you’ll receive general or regional anesthesia. The pre-operative plan is loaded into the Mako system. As I prepare the bone for your implant, the robotic arm provides real-time feedback that keeps the surgical instruments within the precise boundaries of the plan.
The system also tracks very small movements of the knee during surgery and adjusts accordingly. This level of precision would be extremely difficult to achieve consistently with manual instruments alone.
Step 3: Soft Tissue Balancing and Real-Time Adjustments
Here’s what makes Mako particularly valuable for knee replacement specifically. Your knee isn’t a simple hinge — it moves in six distinct directions simultaneously. The ligaments and soft tissue around the joint have to work together with the implant for the knee to feel right after surgery.
The Mako system gives me precise, real-time feedback on your own ligament tension and soft tissue behavior as the knee moves through its range of motion with trial components in place. This allows me to adjust component position based on both the bony anatomy from the CT scan and your individual soft tissue reality. No two patients are the same, and this intraoperative data is what allows the plan to be tailored to what’s actually in front of me.
Step 4: Implant Placement and Final Balancing
Once bone preparation is complete, the knee implant components are placed according to the refined plan. The joint is balanced, and I can make final adjustments as needed before closing. The goal is a knee that tracks naturally, loads evenly, and moves the way a knee is supposed to move.
Benefits of Mako Robotic Knee Replacement
After performing hundreds of robotic-assisted knee replacements, these are the advantages I see consistently in my patients:
- Personalized surgical plan built from your specific CT scan — not a one-size-fits-all approach
- Precise implant alignment and positioning, which directly affects how the knee feels and functions long-term
- Real-time soft tissue feedback that allows intraoperative adjustments for better knee balance
- Preservation of healthy bone and soft tissue — the robotic arm removes only what’s been planned
- Smaller surgical incision and reduced blood loss compared to traditional manual techniques
- Less post-operative pain reported in clinical studies compared to conventional knee replacement
- Faster recovery — most patients walk the same day and return to daily activities within one to four weeks
- The surgeon remains in complete control throughout the entire procedure
Alignment and balance are among the strongest predictors of long-term knee replacement satisfaction. Small differences in positioning can affect how the knee tracks, how the kneecap glides across the front of the implant, and the long-term wear of the polyethylene insert. In my practice, Mako’s precision has made a meaningful difference in delivering consistent results.
What Is Robotic Knee Replacement Recovery Like?
One of the most common questions I hear is about the recovery timeline. Because Mako robotic-assisted surgery allows for more precise bone preparation and better soft tissue preservation, most of my patients experience a smoother recovery compared to what we typically saw with manual techniques.
Here’s what to expect after robotic-assisted total knee replacement:
- Same-day walking: Most patients are up and walking with physical therapy assistance within hours of surgery.
- One to four weeks: The majority of patients return to everyday activities like driving, household tasks, and light errands within this window.
- Six to twelve weeks: Most patients see significant improvement in range of motion and strength. Physical therapy continues during this period.
- Three to six months: Continued improvement. Many patients report their knee feels increasingly natural during daily activities.
Your exact recovery timeline depends on your health and activity level before surgery, your commitment to physical therapy, and other individual factors. But the precision of the Mako system — particularly in soft tissue balancing and implant positioning — is designed to give you the best possible starting point for recovery.
Who Is a Good Candidate for Mako Robotic Knee Replacement?
If you’re experiencing any of the following, robotic-assisted total knee replacement may be worth discussing with an orthopedic surgeon:
- Progressive knee osteoarthritis that limits your daily activities
- Persistent knee pain or stiffness during activity, walking, or getting up from a seated position
- Decreased mobility that keeps you from doing the things you enjoy
- Inadequate relief from non-surgical treatments such as physical therapy, anti-inflammatory medications, cortisone injections, or joint supplements
Most patients who qualify for traditional knee replacement are also candidates for the Mako robotic-assisted procedure. The system is used for both total and partial knee replacements, depending on the extent of joint damage.
Why Dr. Calendine Uses the Mako Robotic System on Every Knee Replacement
I adopted the Mako system because precision in implant positioning has direct implications for how a knee replacement performs and how it feels over time. I don’t use it selectively — I use it on every primary knee replacement I perform.
My relationship with the Mako platform goes beyond clinical use. I serve as a consultant to Stryker — the manufacturer of the Mako system — contributing to the platform’s ongoing development and refinement. I’ve trained surgeons on Mako robotic technique in the United States, China, South Korea, India, and Bali. When other surgeons want to learn the technology, that reflects a level of experience and reproducibility in outcomes that I take seriously.
I also combine the Mako system with the subvastus approach for knee replacement — a muscle-sparing surgical technique that preserves the quadriceps mechanism entirely. The Mako’s robotic precision compensates for the more limited visual access of the subvastus approach, which means you can get the muscle-sparing benefit without any compromise in implant accuracy.
That combination — Mako robotic guidance and the subvastus technique — is the most complete approach I can offer my knee replacement patients.
Schedule a Consultation
If you have pain and stiffness in your knee from osteoarthritis and want to learn more about Mako robotic-assisted knee replacement, I’d welcome the opportunity to evaluate your situation and discuss your options.
Schedule an appointment with me at the Bone and Joint Institute of Tennessee in Franklin, TN. We’ll create a treatment plan based on your specific anatomy and circumstances to help get you back to the activities that matter to you.
Cory Calendine, MD Bone and Joint Institute of Tennessee 3000 Edward Curd Lane, Franklin, TN 37067 (615) 791-2630
→ Schedule a Consultation
This information is for educational purposes and should not replace a professional medical evaluation. Individual results vary based on personal health circumstances. Always consult with a qualified healthcare provider before making decisions about surgery.
If you have pain and stiffness of the knee due to osteoarthritis and want to learn more about joint treatment options and MAKO technology, make an appointment today with Cory Calendine, MD at the Bone and Joint Institute of Tennessee. We’ll devise an effective treatment plan based on your unique circumstances to help provide you with relief and get you moving again.
