10 Steps to Bring Robotic Knee Surgery Into Your OR
Bringing robotic-assisted total knee arthroplasty (raTKA) into the operating room represents a major advancement in precision, reproducibility, and workflow efficiency.1,2 Successfully integrating this technology, however, requires thoughtful planning across clinical, logistical, and administrative touchpoints.
The THINK Surgical TMINI® Miniature Robotic System offers a compact, portable solution designed to fit seamlessly into familiar operative routines while enhancing accuracy and surgeon control.1,2 The ten steps below can help to ensure a smooth and sustainable transition as you adopt TMINI® into your OR.
1. Identify Your Preferred Alignment and Implant Strategies
Before introducing robotics into your surgical workflow, it’s critical to define your preferred alignment philosophy—mechanical, anatomic, or kinematic—as well as your implant selection strategy. A robotic system should complement your surgical approach, not dictate it. Identifying these preferences upfront allows you to configure the TMINI® System in support of your technique and ensures your preoperative plan is as closely aligned to your patient-specific goals as possible.
One of the core aims of total knee arthroplasty is to achieve precise alignment of the femoral and tibial components. Decades of research show that proper alignment is one of the most influential determinants of long-term outcomes after TKA because it reduces mechanical and shear stresses across bearing surfaces and the implant.3,4 In contrast, poorly aligned TKAs have historically been associated with increased wear, reduced functional outcomes, and early loosening, particularly with older polyethylene or implant designs.5,6
Whether your practice favors mechanical, anatomic, or kinematic alignment, consistency in hitting those alignments is key. The TMINI® Miniature Robotic System employs preoperative CT imaging and an overhead active tracking system to ensure bone cuts are precise and accurate to within sub-millimeter tolerances.7 This accuracy and precision can help improve implant positioning relative to the pre-operative plan.1,2
2. Examine Your Imaging Workflow
The TMINI® System is CT-Based. If your practice is not currently sending primary TKA patients for this type of imaging, it’s essential to determine sites where your patients obtain the majority of their care. THINK Surgical’s Clinical Launch Specialist team will make adopting robotics a seamless transition by onboarding your identified imaging centers or radiology departments with the TMINI CT Scan Protocol and providing supporting documentation and training to ensure there are no imaging hiccups as you begin introducing robotics on a regular basis.
If you are routinely using CT scans in your primary knee practice, this will be an easy transition to adopting the TMINI System CT Scan Protocol.
THINK Surgical will handle CT Scan sharing with the imaging center. Depending on imaging locations and your practice’s patient catchment area, you may want to consider additional scanning locations to increase access for patients.
From CT scan to pre-operative plan, you’ll want to budget about 10 business days before surgery to ensure there is enough time to review and approve the plan prior to surgery.
3. Structured Training
Successful implementation depends on a structured training approach that matches the way you and your team learn most effectively. THINK Surgical’s Clinical Launch Specialist team provides thorough in-service training for the surgeons, fellows, residents, scrub-techs, nurses, and sterile processing department staff to ensure they receive thorough education on the TMINI® System. This should extend beyond basic onboarding and could include hands-on labs to include pre-case access to supplemental materials such as instructional videos, quick-reference guides, and procedural checklists that reinforce key steps.
It’s equally important to define roles and responsibilities for PAs, residents, and fellows so they understand their roles throughout the different steps of the procedure. The TMINI® System’s intuitive and adaptable workflow allows these responsibilities to be introduced gradually, matching each learner’s experience level and comfort with the technology. By providing structured instruction, supervised practice, and clear performance expectations, you not only accelerate their proficiency but also reduce the likelihood of OR delays.
4. Prepare for Intraoperative Changes
Robotic Systems inevitably introduce new intraoperative decision points, but the TMINI® Miniature Robotic System is specifically designed to fit smoothly into existing surgical workflows with minimal disruption.
Since it is an open-implant system, it’s imperative that surgeons understand details about the implant system they’ve selected, such as minimum construct thickness and any parameters from the manufacturer around recommended orientations or restrictions, such as a tibial slope recommendation.
Knowing what your patient-specific goal and implant system specifications are can help streamline the intraoperative changes you need to make in the OR, which in turn can help keep your case efficient.
5. Prepare for Your New OR Setup 
The TMINI® Miniature Robotic System separates itself from other robotic systems by having an overhead active tracking system. This means that there are no side line-of-sight issues and your staff do not need to move out of the way during critical surgical steps.
What this also means for your OR setup is that the TMINI® Navigation Console will sit near the contralateral arm-board so the touchscreen monitor is within reach to perform intraoperative adjustments as needed.
The TMINI® System also only uses a single instrument tray in which the TMINI® Robot is also contained. This should keep the sterile tables relatively consistent compared to a manual total knee replacement but reminding the scrub tech what manual instruments are no longer required can assist in reducing instrumentation. The TMINI® System calibration and set up has shown to be as fast as 3.4 minutes.9
Importantly, operative times with the TMINI® System typically follow a short learning curve. Although cases may run slightly longer during initial adoption, most surgeons reach time neutrality with their benchmark procedure after only five to seven cases.10
6. Develop a Plan for Patient Communication
Clear, consistent communication not only helps patients understand the benefits of robotic knee surgery but also plays a critical role in shaping and ultimately fulfilling their preoperative expectations. Many surgeons support this process by giving schedulers scripts or brochures so that messaging begins even before the pre-op visit, and THINK Surgical can assist by providing patient educational materials that explain the TMINI® System’s precision, personalization, and safety.
When your entire team delivers aligned messaging from the first phone call to the day of surgery, patients feel informed, supported, and confident, greatly increasing the chance that their experience matches their expectations, one of the strongest predictors of overall satisfaction.11
7. Establish a Framework for Tracking Outcomes
The use of raTKA systems such as the TMINI® Miniature Robotic System has been shown to improve the accuracy of implant placement,6 and this precision may translate into meaningful clinical benefits over time.6,7 To fully capture the impact of adopting the TMINI® System, establish a structured framework for monitoring key outcomes—which could include alignment consistency, implant sizing accuracy, early functional recovery, and patient-reported satisfaction metrics.
Building this into your workflow from the outset ensures that data collection becomes routine rather than reactive. Whether you rely on internal dashboards, quarterly case audits, or surgeon-led performance reviews, creating a defined feedback loop is essential. Consistent tracking allows you to identify trends, refine your technique, enhance team workflows, and optimize patient selection.
Over time, this continuous evaluation not only strengthens clinical decision-making but also provides compelling evidence of value to patients, administrators, and other stakeholders which reinforces the long-term benefits of robotic precision within your practice.
8. Define Your Expectations for Vendor Support
By clearly defining your expectations upfront, you ensure the right expertise is available exactly when you need it—especially during the formative first weeks of integrating the TMINI® System into your practice. THINK Surgical is focused on providing clinical and technical support throughout the use of the TMINI System, and it begins even before you enter the operating room.
Using TPLAN® Planning Software, THINK Surgical’s advanced software platform, a team of Case Planning Specialists create individualized three-dimensional surgical plans from each patient’s CT scan. These initial plans are then reviewed and approved by the surgeon prior to surgery, ensuring alignment targets, implant sizing, and resection parameters fully reflect your surgical philosophy.
Beyond planning, support can be tailored to your preferred learning style and workflow with the Clinical Launch Specialist team.
9. Complete a Template for Surgical Preferences
Clearly communicating your surgical preferences is essential for efficient planning, and developing a standardized template is one of the most effective ways to ensure those preferences are applied consistently. Well-defined templates can significantly accelerate case preparation by capturing your preferred alignment targets, alignment restrictions, implant choices, and more in a simple, repeatable format.
Completing the Case Planning Preference template allows THINK Surgical to support you with plans that reflect your exact approach. Investing time upfront to complete this structured framework not only streamlines case preparation but also reinforces surgical consistency.
10. Think Ahead to Scale Your Practice
Scaling requires staff readiness, efficient imaging processes, and confidence across your operative team. Planning ahead ensures robotics becomes not just an added tool but a scalable, long-term part of your surgical practice.
As you gain comfort with the TMINI® System, consider how many of your current TKA cases you’d like to transition to robotics. Some surgeons start with select patient groups before expanding, while others transition their entire volume once workflows are optimized.
Conclusion
Integrating robotic knee surgery with the TMINI® Miniature Robotic System becomes far more seamless when surgeons, staff, and processes are aligned from the start. By clarifying preferences, standardizing workflows, and leveraging THINK Surgical’s support, you can create a stable foundation for efficiency, consistency, and measurable clinical value as robotics becomes a lasting part of your practice.
1 Riantho A, Butarbutar JCP, Fidiasrianto K, et al. Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JB JS Open Access. 2023;8(2):e23.00010.
2 Kayani B, Haddad FS. Robotic total knee arthroplasty: clinical outcomes and directions for future research. Bone Joint Res. 2019;8(10):438-442.
3 D’Lima DD, Chen PC, Colwell Jr CW. Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res. 2001;392:232.
4 Pickering S, Armstrong D. Focus on alignment in total knee replacement. J Bone Joint Surg. 2012. http://www.boneandjoint.org.uk/content/focus/alignment-total-knee-replacement. Accessed 30 Nov 2025.
5 D’Lima DD, Hermida JC, Chen PC, Colwell Jr CW. Polyethylene wear and variations in knee kinematics. Clin Orthop Relat Res. 2001;392:124.
6 Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;428:26.
7 Data is based on TMINI System assisted placement of cut guide compared to planned placement.
8 Kayani B, Haddad FS. Robotic total knee arthroplasty: clinical outcomes and directions for future research. Bone Joint Res. 2019;8(10):438-442.
9 Data is based on average set-up time achieved by case 25 (excluding TMINI Miniature Robotic System warm up time).
10 Experience Adopting the TMINI Miniature Robotic System. Under Review for presentation at: Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS); November 7, 2024; Dallas, USA.
11 Rodriguez-Merchan EC. Patient Satisfaction Following Primary Total Knee Arthroplasty: Contributing Factors. Arch Bone Jt Surg. 2021;9(4):379-386.
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