ROBOTIC-ASSISTED KNEE REPLACEMENT
The Robotic Revolution: Elevating Perioperative Nursing Practice Through Innovation and Partnership
The Nurse's Role, and the Benefits Against Conventional Surgery
Prepared by: YVONNE MAKOKHA & ELVIS OMONDI
METROPOLITAN HOSPITAL, NAIROBI
OVERVIEW
What Is Robotic-Assisted TKR?
THE ROBOT DOES NOT OPERATE ALONE
It is a precision instrument controlled entirely by the surgeon, supported at every stage by a coordinated theatre nursing team.
Common platforms include Mako and ROSA robotic systems, used with CT- or image-based planning. Metropolitan Hospital uses the MISSO
The Robotic Revolution: Elevating Perioperative Nursing Practice Through Innovation and Partnership
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NURSE'S ROLE · 1 OF 3
Pre-Operative Phase
Assessment & Baseline
History, vitals, and baseline range-of-motion documentation
Patient & Family Education
Explaining the robotic procedure, expectations, and prehabilitation
Imaging Coordination
Scheduling the pre-op CT scan used for robotic surgical planning
Consent & Concerns
Verifying informed consent; addressing anxieties about the robotic system
Theatre Readiness
Skin prep, site marking, and confirming implants/instrumentation are ready
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NURSE'S ROLE · 2 OF 3
Intra-Operative — Scrub Nurse
Passes specialised robotic instrumentation: tracking pins, arrays, and registration probes
Performs sterile draping of the robotic arm itself — distinct from conventional instrument draping
Maintains strict sterility around the additional robotic equipment and cabling in the field
Supports the surgeon during registration and mapping, as the robot builds the 3D knee model
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NURSE'S ROLE · 3 OF 3
Post-Operative Phase
Recovery Monitoring
PACU vitals, pain scores, and neurovascular checks of the operated limb
Pain Management
Multimodal analgesia; monitoring regional block wear-off
Wound & Drain Care
Dressing checks and drain management where used
DVT Prevention
Mechanical and pharmacological prophylaxis, plus early mobilisation
Rehab & Discharge Education
Coordinating physiotherapy; teaching weight-bearing status and home exercises
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NURSE'S ROLE · 2 OF 3
Intra-Operative — Circulating Nurse
Sets up the theatre and positions the patient to accommodate the robotic arm and tower
Ensures unobstructed line-of-sight for the robot's tracking arrays throughout the case
Documents intra-operative events and manages instrument, sponge, and needle counts
Anticipates equipment needs and manages the OR environment around added robotic hardware
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BENEFITS VS. CONVENTIONAL · 1 OF 3
Precision & Surgical Planning
CONVENTIONAL TKR
ROBOTIC-ASSISTED TKR
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BENEFITS VS. CONVENTIONAL · 2 OF 3
Recovery & Pain Outcomes
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Soft-Tissue Trauma
Precision cuts are associated with less soft-tissue disruption than the more extensive releases sometimes needed conventionally.
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Early Pain & Swelling
Several studies report modestly reduced early post-operative pain and swelling with robotic assistance.
3
Mobilisation
More precise soft-tissue handling supports faster early functional recovery in some patients.
Note: long-term functional outcome differences between robotic and conventional TKR remain an active area of research.
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SUMMARY
At a Glance: Robotic vs. Conventional TKR
Aspect | Robotic-Assisted | Conventional |
Surgical planning | CT-based 3D pre-op plan | Intra-op landmarks |
Alignment precision | High consistency | More variable |
Early pain/swelling | Modestly reduced (evidence-based) | Standard |
Operative time | Longer | Shorter |
Cost | Higher | Lower |
Long-term outcome data | Limited, growing | Well established |
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BENEFITS VS. CONVENTIONAL · 3 OF 3
Trade-Offs to Weigh
Operative Time
Robotic cases typically run longer due to registration, mapping, and robotic setup.
Cost
Higher cost from equipment, CT imaging, and per-case licensing/consumables.
Learning Curve
Additional training required for surgical and theatre teams to reach proficiency.
Long-Term Evidence
Robotic TKR has a shorter track record; long-term revision-rate data is still accumulating.
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KEY TAKEAWAYS
The Nurse Remains Central to a Safe Outcome
The robot assists the surgeon's precision — it does not replace coordinated nursing care across all three phases of surgery.
Robotic assistance offers measurable gains in alignment accuracy and, in several studies, early recovery.
Higher cost, longer operative time, and a real training/learning curve are genuine trade-offs to plan for.
Long-term outcome evidence is still maturing — conventional TKR still has the deeper long-term track record.
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