16% & Climbing: The Increasing Adoption of Robotic Knee Replacement
As an emerging technological advancement, robotic-assisted total knee arthroplasty (raTKA) aids surgeons in improving the precision of bone cuts, mechanical alignment restoration, and implant positioning.1 Thanks to benefits like these, the adoption of robotic assistance over the past decade has risen dramatically.2
For example, 2017 data indicated that only 1.8% of TKA procedures utilized robotic assistance.2 Fast forward to 2024, when the results of an American Joint Replacement Registry (AJRR) report noted the use of robotic technologies in approximately 16% of all primary TKAs performed in the prior year.2
Numerous factors likely contributed to this rapid growth, but principal among them are the surgeons themselves, who have identified raTKA as a means of reducing postoperative complications, opioid consumption, and the length of hospital stays.3
Let’s explore the shift toward a preference for robotic-assisted technology among clinicians, patients, and hospital administrators alike, and what the future may hold for raTKA.
Why Are More Surgeons Switching to Robotic Knee Surgery?
1) Plan-to-implant precision and fewer alignment outliers
Compared to manual jig-based techniques, evaluations of implant placement and limb alignment after raTKA consistently demonstrate greater accuracy to plan and fewer malalignment outliers.4,5 Clinical studies have consistently demonstrated the superior accuracy of raTKA, evidencing its capability to achieve femoral and tibial resections within one degree of the intended alignment in the majority of cases.5
For example, a meta-analysis of randomized controlled trials conducted by The Journal of Bone and Joint Surgery (JBJS) concluded that raTKA produced fewer outliers in several coronal alignment parameters, even when mean angles were similar between groups.4
Robotic assistance has been shown to minimize the reliance on soft tissue releases when compared to traditional total knee arthroplasty.7 The TMINI PRO™ Workflow for Positional Refinement and Optimization illustrates this particular benefit by facilitating intraoperative adjustments that refine implant positioning and stability potentially without the need for unnecessary soft tissue release.6
2) Less pain, earlier mobilization, shorter length of stay
Although more research is needed to support the long-term functional superiority of raTKA methods, early postoperative advantages have repeatedly been reported.7-9 Patients receiving raTKA procedures in one study have exhibited lower levels of post-operative pain, reduced opioid use, faster progression to a straight-leg raise, and shorter hospital stays.⁸
Again, these advantages are attributed to a reduction in soft-tissue trauma and improved accuracy in component positioning, as supported by a transient reduction in systemic inflammatory markers.⁹ Robotic-assisted techniques have also been associated with improved Knee Society Function Scores (KSFS) at six months, one year, and two years post-procedure.7
3) Manageable learning curves
Learning to utilize new technology may increase operative times when first introduced, but the TMINI® Miniature Robotic System combines robotic precision with instruments surgeons are comfortable with, which may help reduce the learning curve.
The learning curve for operative times when using the TMINI robot can be measured in single digits for many surgical teams.10 In as few as 5 to 7 cases, orthopedic surgeons were able to improve their operative times and achieve time neutrality compared to traditional TKA procedures.10
What’s Driving Patient Demand for Robotic Procedures?
1) Patient perception of personalization and precision
As patients become aware of the potential for improved precision and personalization with robotic-assisted technologies, demand for raTKA procedures continues to rise. With technology like the TMINI® Miniature Robotic System, surgeons can develop detailed preoperative plans specific to the patient’s anatomy.
The TMINI® Miniature Robotic System offers the most implant systems and design philosophies of any orthopedic robotic system currently available in the US.11 The open implant platform gives surgeons the freedom to select implants based on patient-specific needs rather than being confined to one implant system’s offering.
The TMINI PRO™ Workflow for Positional Refinement and Optimization, gives surgeons the ability to adjust surgical plans intraoperatively based on patient-specific anatomy, providing personalization in TKA. Combined with the ability to do real-time verification of bone cutting accuracy, the TMINI System can help provide confidence in patient-specific planning.
2) Recovery-focused values
Clinical research supports the ability of raTKA to give patients a greater chance of discharge home after the procedure and improves the likelihood of an earlier functional recovery.13 Return to normal life is a key concern for many patients considering TKA.12 Such patients find the shorter hospital stays, earlier functional milestones, and lower postoperative pain associated with robotic-assisted procedures appealing.3
3) Word-of-mouth and health-system branding
As more centers market robotic arthroplasty and more neighbors return to activity quickly, demand for access to raTKA technology continues to rise, irrespective of the nuances of platform or alignment philosophy. This rise in popularity may, in part, be due to an increase in awareness of robotic assistance in TKA procedures (as well as its potential benefits) among the general public.
The TMINI® Miniature Robotic System is revolutionizing this perspective by offering surgeons and patients more choices when it comes to the raTKA. As more patients are willing to travel for healthcare, centers offering robotics have become increasingly in demand, especially as more data becomes available regarding potential benefits on raTKA.
How Do Hospitals Justify the Investment in Robotic Systems?
When healthcare institutions are faced with the choice of implementing a robotic system, economic considerations play a crucial role. The facility must evaluate the total costs associated with each system. Administrators typically balance these costs against service-line growth, perioperative efficiency, and post-hospital discharge savings.
1) Potential savings from raTKA utilization
Robotics can impact downstream healthcare utilization and potentially reduce long-term costs by reducing readmissions.14 The use of fewer hospital resources from a shorter length of stay and fewer post-acute services also helps to improve savings for organizations, especially within bundled payment models.14
In a cohort of raTKA and traditional TKA patients, the raTKA patients demonstrated lower 90-day episode-of-care (EOC) costs.14 These savings were attributed to lower early readmission rates and more economically beneficial discharge destinations.14
2) Volume thresholds and cost-effectiveness
Integration of robotic-assisted technology is likely to be more cost-effective for high-volume centers where fixed capital costs are spread across more cases and because experienced teams minimize added OR time.15 When considering cost-effectiveness in a Medicare population, raTKA is cost-effective compared to traditional TKA in centers conducting at least 50 cases/year.15
These volume thresholds can be further impacted by operating room efficiency and workflows. For instance, the TMINI® Miniature Robotic System can reduce the number of trays, with all robotic instruments fitting within one tray, and requires an average setup time of only six minutes.16 By minimizing sterile-field clutter and inventory burden, these additional operative efficiencies may positively affect the cost-effectiveness of raTKA.
3) Strategic growth and case-mix optimization
Hospitals often justify robotic technology as a catalyst for market share growth and expansion of outpatient TKA, which can help to offset implementation and maintenance costs. Early-recovery signals and LOS reductions support the shift of knee replacement surgery from inpatient to outpatient facilities, which can dramatically change profit margins.14
What Does the Future Hold for Robotic Knee Replacement Technology? 
1) Increased utilization
The 2024 AJRR report documents a rapid rise in robotic use in primary TKA since its inception.2 While the utilization is estimated at approximately 16% of primary TKA cases, integration of robotic systems is projected to grow as more data is obtained.13 A greater push for outpatient services is expected and rising familiarity among surgeons may drive an increase in demand for these technologically advanced systems.2
2) Open platforms and handheld devices
It is safe to say the future of raTKA is heading towards increased customization and a wider selection of implants for surgeons to help provide the best options for patients. THINK Surgical has already developed an innovative approach to raTKA using a miniature, handheld, wireless robotic system with sub-millimeter and sub-degree accuracy and precision.17 Overhead active tracking cameras reduce the bedside footprint associated with other robotic platforms, allowing surgeons unrestricted patient access.
With an open platform, surgeons have the most implant systems and design philosophies available of any orthopedic robotic system currently available in the US at their disposal. To further increase personalization of the raTKA, the TMINI® Miniature Robotic System is equipped with TMINI PROTM Workflow, empowering surgeon choice throughout the procedure by enabling Positional Refinement and Optimization (PRO) of the implant to meet the patient’s anatomic needs.
3) Patient preference
The rapid increase in raTKA procedures is directly related to an increase in consumer pull for “robotic” procedures and is unlikely to wane. As more procedures are performed, there is an increasing likelihood that patients will have an interaction with a friend, neighbor, or stranger who shares their positive experiences with this operation. This word of mouth will continue to drive the demand, and as long-term data is obtained, raTKA is likely to be a longstanding option in orthopedics.
Conclusion
Robotic-assisted total knee arthroplasty (TKA) has gained significant traction in the United States, with reports indicating that it now accounts for approximately one in six primary knee procedures in various healthcare settings.2 The clinical advantages of this technology are particularly compelling, as studies show it results in improved precision with fewer alignment errors, promotes quicker recovery times characterized by reduced pain and shorter lengths of stay, and demonstrates non-inferior early survivorship rates compared to traditional manual techniques.3,4,8
From an economic standpoint, the benefits are most pronounced in high-volume practices, where efficiencies can lead to significant cost savings and market growth.15 Looking ahead, we can anticipate a continued increase in the adoption of robotic systems, accompanied by more refined evidence identifying the specific patient populations and alignment strategies that reap the most benefits. Additionally, there will be ongoing initiatives aimed at enhancing the delivery of this technology more efficiently and cost-effectively.
1 Ren Y, Cao S, Wu J, Weng X, Feng B (2019) Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 95(1121):125–133.
2 The AJRR Annual Report. https://www.aaos.org/registries/publications/ajrr-annual-report/. Accessed 8.28.2025.
3 Wang JC, Piple AS, Hill WJ, et al. Computer-Navigated and Robotic-Assisted Total Knee Arthroplasty: Increasing in Popularity Without Increasing Complications. J Arthroplasty. 2022;37(12):2358-2364.
4 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.
5 Kayani B, Haddad FS. Robotic total knee arthroplasty: clinical outcomes and directions for future research. Bone Joint Res. 2019;8(10):438-442.
6 TMINI 1.1 FDA 510(k) Press Release.
7 Spitzer A, Gorab R, Barrett W, et al. Robotic-assisted total knee arthroplasty reduces soft-tissue releases which improves functional outcomes: A retrospective study. Knee. 2024;49:52-61.
8 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J. 2018;100-B(7):930-937.
9 Kayani B, Tahmassebi J, Ayuob A, Konan S, Oussedik S, Haddad FS. A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty. Bone Joint J. 2021;103-B(1):113-122.
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 MKG-24-09 ID-HUB Interactive Brochure.
12 Rastogi R, Chesworth BM, Davis AM. Change in patient concerns following total knee arthroplasty described with the International Classification of Functioning, Disability and Health: a repeated measures design. Health Qual Life Outcomes. 2008;6:112.
13 Khan ST, Emara AK, Zhou G, et al. Robotic-assisted total knee arthroplasty in the USA: Nationwide adoption trends towards 70% by 2030. J Clin Orthop Trauma. 2025;68:103069.
14 Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res. 2019;8(5):327-336.
15 AAOS Now (July 2025). Economic modeling summary: cost-effectiveness likely ≥~50 cases/year.
16 Data is based on average set-up time achieved by case 25 (excluding TMINI Miniature Robotic System warm up time).
17 Data is based on TMINI System assisted placement of cut guide compared to planned placement.
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