Knee replacement aims to relieve pain and restore confident movement. One issue that can affect comfort after surgery is how the kneecap moves in its groove, known as patella tracking. An international study co-authored by Dr Jobe Shatrov, published in JISAKOS, explored whether robotic assistance helps surgeons achieve more reliable patella tracking in total knee arthroplasty.

Read the full paper: https://www.jisakos.com/article/S2059-7754(24)00123-8/fulltext

Why patella tracking matters

The kneecap (patella) sits in a shallow channel on the end of the thigh bone called the trochlea. As you bend and straighten the knee, the patella glides in this groove. If the pathway is not ideal, the kneecap may track a little off to one side. Patients can notice discomfort when standing from a chair, going downstairs or kneeling. Good tracking reduces grinding sensations, improves confidence and supports function in daily life and sport.

What robotic assistance actually does

Robotic systems help surgeons plan bone cuts and component positions with a high level of precision. Before any cut is made, the system shows how changes in alignment or rotation may affect soft-tissue tension and overall knee balance. During the operation the robot guides the plan and allows real-time adjustments.

Important points for patients:

• Robotics can improve the accuracy and consistency of component placement.

• Robotics does not replace surgical judgment. The surgeon still decides how to optimise alignment for each individual knee.

• Good patella tracking depends on several factors at once: femoral and tibial component position, implant design, and soft-tissue balance around the patella.

What the research asked

The study brought together data and expertise from multiple centres to examine whether robotically assisted total knee arthroplasty produces more predictable patella tracking. In practical terms, the authors wanted to know:

• Does robotic guidance help align the femoral component and trochlear groove in a way that supports central patella tracking

• Do the intraoperative checks that robots enable translate into what patients feel after surgery

• Where are the remaining gaps that future research and implant design need to address

What the study found

The headline message is balanced. Robotic systems provide accurate, reproducible bone preparation and can help surgeons fine-tune component rotation, slope and alignment. These features can support better patellofemoral mechanics. At the same time, patella tracking remains complex. Not every knee achieves perfect tracking just because a robot is used, and some cases still need careful soft-tissue releases or specific implant choices to optimise the patellofemoral joint.

In short, robotics is a valuable tool, not a guarantee. The best outcomes come from combining precise planning, sound surgical technique and thoughtful rehabilitation.

Read the full paper for technical detail: https://www.jisakos.com/article/S2059-7754(24)00123-8/fulltext

What this means for patients who are considering knee replacement

If you are weighing up robotic surgery, it helps to understand what it can and cannot do.

Where robotics adds value

• More consistent reproduction of the pre-operative plan

• Ability to preview how component changes might influence patella mechanics

• Finer adjustments to alignment and soft-tissue balance

What still matters just as much

• Your anatomy and cartilage wear pattern

• Implant design, especially the shape of the trochlear groove

• Soft-tissue tension around the patella and quadriceps strength after surgery

• A rehabilitation plan that restores range, strength and movement control

A practical pathway to support good patella tracking

Dr Shatrov’s approach focuses on three phases.

1. Pre-operative planning

• Careful review of limb alignment, femoral and tibial anatomy and patella position

• Discussion of implant options that offer a trochlear shape suited to the patient’s anatomy

• Consideration of robotic or computer-assisted planning when it adds precision

2. Intraoperative decision-making

• Accurate component placement with verification of rotation and balance

• Assessment of patella tracking through range, with adjustments as needed

• Selective resurfacing of the patella when indicated

3. Targeted rehabilitation

• Early range of motion with full extension and progressive flexion

• Quadriceps and hip strengthening to centralise patella pull

• Gait training and stair practice to reduce excessive patellofemoral load

• Gradual return to work and sport, guided by symptoms and function

Frequently Asked Questions

Is robotic knee replacement better for the kneecap
Robotic assistance can improve the accuracy of component positioning, which may support patella tracking. Results still depend on implant design, soft-tissue balance and rehabilitation.

Will my kneecap be resurfaced
Not always. Whether to resurface the patella depends on cartilage quality, symptoms and implant design. Your surgeon will discuss the pros and cons for your knee.

What can I do to help the kneecap track well after surgery
Follow the rehabilitation plan, focus on quadriceps and hip strength, keep swelling controlled, and progress stairs and kneeling gradually. Report persistent catching or pain so your team can review early.

Key takeaways

• Patella tracking is important for comfort after total knee replacement.

• Robotic assistance improves planning and precision, which can support better patellofemoral mechanics, but it is not a guarantee.

• Outcomes depend on the combination of accurate component alignment, appropriate implant choice, soft-tissue balance and high-quality rehabilitation.

• An individualised plan with clear goals gives the best chance of a smooth and confident recovery.

Read the full paper: https://www.jisakos.com/article/S2059-7754(24)00123-8/fulltext

Learn more

• Total and partial knee replacement (insert internal link)

• Robotic knee surgery (insert internal link)

• Patella instability and dislocation (insert internal link)

• About Dr Jobe Shatrov (insert internal link)