The Ultimate Guide to Total Knee Replacement with Mako Robotic-Arm Assisted Surgery

Clinically reviewed by Prem N. Ramkumar, MD, MBA — Dual fellowship-trained orthopedic surgeon at Commons Clinic Updated: March 2026 | Read time: 17 minutes

When Your Knee Starts Making Decisions for You

It's not the sharp pain that finally brings most people in. It's the slow accumulation of everything they've stopped doing. The walk they used to take after dinner. The stairs they now avoid. The way they instinctively scan a restaurant for a seat near the door so they don't have to navigate through tables. Knee osteoarthritis is rarely dramatic — it's incremental, which makes it easy to accommodate for years before you realize how much ground you've lost.

If you've reached the point where the knee is making decisions your brain hasn't agreed to, a total knee replacement may give you those decisions back. And the technology that now powers this procedure — particularly Mako robotic-arm assisted surgery — has made the operation more precise, the recovery faster, and the results more predictable than at any point in the history of orthopedics.

What Is Total Knee Replacement?

Total knee replacement (also called total knee arthroplasty) is a surgical procedure that removes damaged cartilage and bone from the knee joint and replaces them with precision-engineered metal and plastic components that recreate the natural function of the knee.

The knee joint is formed where the thighbone (femur) meets the shinbone (tibia), with the kneecap (patella) gliding across the front. In a healthy knee, smooth cartilage covers the ends of these bones and allows them to move against each other with almost no friction. When osteoarthritis destroys this cartilage, the exposed bone surfaces grind together — causing pain, stiffness, swelling, and progressive loss of function.

Total knee replacement removes the damaged surfaces and replaces them with components specifically sized and shaped for your anatomy. The femoral component (a smooth metal cap) covers the end of the thighbone. The tibial component (a metal plate with a plastic bearing surface) covers the top of the shinbone. And a plastic spacer between them recreates the smooth, low-friction surface that cartilage once provided.

More than one million total knee replacements are performed in the United States each year, making it one of the most successful and well-studied procedures in all of surgery. Modern implants are designed to last 20 to 25 years or longer.

What Is Mako Robotic-Arm Assisted Surgery?

Mako is a robotic surgical system developed by Stryker that transforms total knee replacement from a procedure guided by the surgeon's eye and hand alone into one guided by 3D computed tomography (CT), real-time intraoperative data, and a robotic arm that provides haptic (touch-based) feedback.

It's important to understand what Mako is — and what it isn't. The robot does not perform the surgery. It does not make decisions. It does not move autonomously. Your surgeon controls every aspect of the procedure. What the Mako system does is provide your surgeon with a level of information and precision that was simply not available before.

How It Works

Before surgery: A CT scan of your knee creates a patient-specific 3D virtual model. Your surgeon uses this model to plan the exact size, position, and alignment of every implant component before you enter the operating room.

During surgery: The Mako robotic arm acts as a precision instrument in your surgeon's hands. As the surgeon shapes the bone to receive the implant, the system provides real-time visual guidance and haptic (resistance) feedback. If the surgical tool approaches the boundary of the pre-planned cutting zone, the robotic arm physically resists — preventing the surgeon from removing bone beyond what the plan calls for. This is Stryker's AccuStop technology.

The system also allows the surgeon to assess soft tissue balance and ligament tension intraoperatively — adjusting the plan in real time based on how your specific knee behaves under load. This dynamic balancing is one of the most significant advantages of the Mako platform.

The result: Studies published in peer-reviewed journals have demonstrated that Mako robotic-arm assisted total knee replacement delivers more accurate implant placement, improved soft tissue balance, and higher patient satisfaction scores compared to conventional manual techniques.

When to Consider Total Knee Replacement

You May Be a Candidate If:

• You have been diagnosed with osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis of the knee
• Pain limits your daily activities — walking, climbing stairs, getting in and out of chairs, sleeping
• Stiffness or swelling in the knee restricts your range of motion
• Non-surgical treatments — physical therapy, anti-inflammatory medications, cortisone injections, viscosupplementation, activity modification — no longer provide adequate relief
• X-rays show significant joint space narrowing or bone-on-bone contact
• Your quality of life has materially declined because of the knee

When It's Too Early

If you still have meaningful cartilage remaining, your pain is manageable with conservative measures, or you haven't yet tried structured physical therapy and injection-based treatments, your surgeon may recommend continuing non-operative care. A partial knee replacement or biologic injection may also be appropriate as an intermediate step for some patients.

"I never want to do a knee replacement on someone who didn't need one," says Dr. Prem Ramkumar, a dual fellowship-trained orthopedic surgeon at Commons Clinic specializing in hip and knee conditions. "But I also don't want someone suffering for three extra years because they think they need to be 'old enough' for a replacement. There's no age threshold. There's a quality-of-life threshold."

How Total Knee Replacement with Mako Works

Before Surgery

Your surgical team obtains a CT scan of your knee approximately two to four weeks before the procedure. The Mako system uses this scan to generate a precise 3D model of your joint. Your surgeon reviews this model, selects the optimal implant size, and plans the alignment and positioning of each component.

You will receive a pre-operative evaluation to ensure you are medically optimized for surgery. This includes blood work, cardiac clearance if indicated, and a review of your medications.

During Surgery

The procedure is performed under anesthesia (general, spinal, or regional, depending on your surgeon's assessment and your preference). Total operative time is typically 60 to 90 minutes.

Your surgeon makes an incision along the front of the knee — typically 6 to 8 inches depending on body habitus. The damaged cartilage and bone are removed using the Mako robotic arm, which guides each bone cut according to the pre-operative plan. The robotic arm's AccuStop technology ensures each cut stops precisely where planned.

The surgeon then trial-fits the components and assesses alignment, stability, and range of motion — both visually and using the Mako system's real-time data. Adjustments are made as needed. Once the fit is confirmed, the final implant components are cemented into place.

The incision is closed, and you are moved to the recovery area.

After Surgery

At MOSI, Commons Clinic's outpatient surgery center in Marina del Rey, many total knee replacements are performed on an outpatient basis — meaning you go home the same day. Whether you go home the same day or stay overnight depends on your overall health, your home support system, and your surgeon's assessment.

Physical therapy begins the day of surgery. You will be up and walking — with assistance — within hours of the procedure.

Mako Robotic Knee Replacement vs. Conventional Knee Replacement

"The Mako system doesn't replace surgical judgment — it amplifies it," says Dr. Ramkumar. "Every decision still comes from the surgeon. But now those decisions are informed by a level of data and precision that didn't exist when I trained. The patients feel the difference."

Recovery Timeline

Day of surgery: Up and walking with physical therapy. Many patients go home the same day from MOSI.

Week 1 to 2: Home-based recovery with prescribed exercises. Ice, elevation, and a structured pain management protocol. Most patients are off narcotic pain medication within five to seven days. A physical therapist visits or you begin outpatient PT.

Week 2 to 4: Range of motion improves significantly. Most patients can walk short distances without a cane or walker. Driving typically resumes at two to three weeks (for the non-operative leg) or four to six weeks (for the operative leg with automatic transmission).

Week 4 to 8: Return to most daily activities. Light household tasks, shopping, cooking, desk work. Physical therapy focuses on strengthening and gait normalization.

Month 2 to 3: Progressive return to recreational activities. Walking, stationary cycling, swimming, and golf are common early resumptions.

Month 3 to 6: Continued improvement. Most patients report their knee "feeling normal" somewhere in this window. Higher-demand activities are cleared on an individual basis.

Month 6 to 12: Final gains in strength and confidence. Many patients describe forgetting which knee was replaced — the highest compliment in joint surgery.

Commons Clinic's physical therapy team, including Dr. Brett Pugh, DPT, works directly with the surgical team to ensure your rehabilitation is coordinated, progressive, and aligned with your specific goals.

Benefits and Risks

Benefits

Total knee replacement with Mako robotic assistance offers significant pain relief, restored mobility, and improved quality of life for patients with advanced knee arthritis. Published data shows over 90% of patients report satisfaction with the procedure. The Mako system's precision translates to more accurate implant alignment, better soft tissue balance, less post-operative pain in early recovery, and high implant longevity.

Risks

As with any major surgery, total knee replacement carries risks including infection (less than 1% at high-volume centers), blood clots, stiffness, nerve or blood vessel injury, and implant wear or loosening over time. Your surgeon will discuss your individual risk profile and strategies for mitigation, including pre-operative optimization, VTE prophylaxis, and structured rehabilitation.

Why Patients Choose Commons Clinic for Robotic Knee Replacement

Dr. Prem N. Ramkumar, MD, MBA is a dual fellowship-trained orthopedic surgeon specializing in hip and knee conditions with expertise in robotic-assisted joint replacement. Dr. Ramkumar brings a unique combination of clinical training and systems-level thinking to every case — his dual fellowship and MBA inform an approach that considers not just the surgical technique but the entire patient journey from consultation through full recovery.

What sets Commons Clinic apart:

• Extended consultation time. Commons Clinic patients spend nearly three times longer with their surgeon than the national average, ensuring the right procedure is chosen for the right patient.
• Mako robotic-arm assisted surgery. Sub-millimeter precision in implant placement, guided by patient-specific 3D CT planning and real-time intraoperative data.
• Outpatient surgery at MOSI. Marina Orthopedic and Spine Institute is a fully accredited ambulatory surgery center purpose-built for joint replacement — not a hospital operating room. The outpatient setting means lower infection risk, a more comfortable environment, and no unnecessary hospital stay.
• Vertically integrated care. Imaging, surgery, physical therapy, and pain management under one roof. Your surgical team and your rehab team work together — literally down the hall from each other.
• Care Guarantee. A two-year warranty covering the full cost of professional follow-up care, including physical therapy and revision surgery if needed.
• Virtual consultations nationwide. Commons Clinic's virtual specialty clinic provides initial consultations and second opinions via telehealth for patients outside Los Angeles.

Frequently Asked Questions

How long does a Mako robotic knee replacement take?

The surgical procedure typically takes 60 to 90 minutes. Including pre-operative preparation and post-operative recovery room time, plan for approximately four to six hours at the surgery center.

Is the robot doing the surgery?

No. The Mako robotic arm is a precision tool controlled entirely by your surgeon. It provides real-time guidance and haptic (resistance-based) feedback, but every cut, every decision, and every adjustment is made by the surgeon. The system cannot move without the surgeon guiding it.

How long does a knee replacement last?

Modern total knee implants are designed to last 20 to 25 years or longer. Published registry data shows over 90% of implants surviving at 20 years. The precision of Mako robotic placement may extend implant longevity further by optimizing alignment and reducing abnormal wear patterns.

Can I kneel after knee replacement?

Most patients can eventually kneel, though it may feel different than before surgery. The kneecap area often feels numb or hypersensitive for several months. Many patients find that kneeling on a padded surface becomes comfortable within six to twelve months.

Is total knee replacement covered by insurance?

Yes. Total knee replacement is covered by all major insurance carriers. Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by surgery benefit plans through Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket cost.

Am I too young — or too old — for knee replacement?

There is no strict age cutoff. The decision is based on your level of pain, functional limitation, failure of conservative treatments, and overall health. Patients in their 40s and 50s increasingly undergo knee replacement when their quality of life warrants it — and patients in their 80s and 90s safely undergo the procedure when they are otherwise healthy.

What activities can I do after knee replacement?

Most patients return to walking, cycling, swimming, golf, doubles tennis, hiking, and travel. Higher-impact activities like running and singles tennis are generally discouraged to protect implant longevity, though some patients engage in these activities at their own discretion.

What's the difference between total and partial knee replacement?

Partial (unicompartmental) knee replacement resurfaces only the damaged portion of the knee, preserving the healthy compartments and ligaments. It's appropriate when arthritis is limited to one area of the knee. Total knee replacement resurfaces the entire joint and is appropriate when arthritis affects multiple compartments. Both can be performed with Mako robotic assistance at Commons Clinic.

Key Takeaways

• Total knee replacement with Mako robotic-arm assisted surgery offers precision implant placement guided by patient-specific 3D CT planning and real-time intraoperative data
• The robot does not perform surgery — it amplifies the surgeon's precision with haptic feedback and boundary control
• Most patients go home the same day from MOSI, walking within hours of the procedure
• Recovery milestones: desk work in two to four weeks, driving in two to six weeks, recreational activities in two to three months
• Modern implants are designed to last 20 to 25 years or longer
• Over 90% of appropriately selected patients report satisfaction with total knee replacement

Take the Next Step

If knee arthritis is limiting the life you want to live, a consultation with a fellowship-trained joint replacement surgeon is the best next step.

Dr. Prem N. Ramkumar and the Commons Clinic joint replacement team see patients at clinics across Los Angeles — including Santa Monica, Marina del Rey, Beverly Hills, and Long Beach — and perform robotic-assisted joint replacement at MOSI in Marina del Rey.

Not in Los Angeles? Commons Clinic's virtual specialty clinic offers initial consultations and second opinions nationwide via telehealth.

Insurance: Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket treatment.

Schedule a consultation: Call (310) 437-7921 or email hello@commonsclinic.com

Sources: The Journal of Arthroplasty, Journal of Bone and Joint Surgery, Stryker Clinical Evidence, American Joint Replacement Registry, American Academy of Orthopaedic Surgeons