Robotic Orthopedic Surgery Clinic for Knee and Hip

The technological revolution in prosthetic materials, through biomedical engineering, has enabled us to plan the implanted prosthesis robotically so that the new “bionic” joint can replicate the durability and movement of the natural joint.

Bionic knee and hip prostheses are designed to interact with the digital environment. “Artificial intelligence” is integrated into the patient’s joint, enhancing mobility and functionality beyond expected levels and earlier than previously anticipated.

Even when navigation systems are used instead of robotic systems, patients follow a specific preoperative protocol. For example, the “bionic knee” which represents the evolution of all types of knee prostheses, is so well assimilated by the patient’s body that it mimics the natural joint. It flexes, extends, moves effortlessly, remains stable, provides confidence in weight-bearing, is pain-free, and is durable over time.

All recent studies demonstrate long-term survival of these prosthetic materials (beyond 25–30 years) in more than 90% of cases, allowing surgical intervention even in younger patients.

The procedure is performed based on an individualized preoperative planning model, which is approved or modified by the treating physician.

In this way, the prosthetic components are adapted to the patient’s anatomy and not vice versa. Bone is not resected indiscriminately; instead, the prosthesis is adapted to the bone, replacing only the affected part.

All procedures are performed using minimally invasive approaches (M.I.S.), which limit muscle damage, minimize blood loss, and enable immediate postoperative mobilization.

Special fast-track protocols are implemented by the experienced staff of the Clinic and begin with preoperative patient education. They are combined with regional anaesthesia, without the use of opioid medications, immediate mobilization and ambulation, and are completed with 24-hour hospitalization. The patient is admitted, evaluated, operated on, mobilized, and discharged home within 24 hours. Continuous 24-hour medical and nursing support is provided.

State-of-the-art navigation sensors confirm the initial surgical plan intraoperatively, while advanced robotic arms (Μako SmartRobotics/Stryker & Rosa/ Zimmer-Biomet) execute the procedure with millimetre accuracy.

• smaller incision
• minimal postoperative scar
• reduced muscle damage
• elimination of blood loss, avoiding the need for transfusion
• reduced operative time
• avoidance of catheters and drains
• immediate mobilization and ambulation due to preservation of the extensor mechanism

• minimization of complications (inflammation, thrombophlebitis)
• mental clarity (absence of dizziness and nausea)
• minimization of postoperative pain
• 24-hour hospitalization (in the absence of comorbidities)

The “smart robot” combines three distinct elements:

• three-dimensional preoperative planning based on CT imaging
• precision of osteotomies within predefined limits
• intraoperative data analysis

Surgical error is minimized, as the robotic system does not execute commands in unmapped areas of the joint that are not registered in its system. It ensures precise placement of prosthetic components and provides superior outcomes in comparative studies versus conventional arthroplasty.

The use of the Mako robotic system, which is available at Metropolitan Hospital and Hygeia, also members of the Hellenic Healthcare Group, and is the first “semi-active” or “surgeon-guided” robotic system in Greece provides:

• individualized three-dimensional modelling per patient
• precision in the placement of femoral and tibial components, while in hip arthroplasty it guides implant positioning according to patient-specific anatomy
• preservation of bone stock
• stable knee and stable gait
• preservation of bone marrow integrity
• successful outcomes in all patients, regardless of body type
• correction of limb length discrepancy
• elimination of inflammatory response
• excellent functional outcome of knee and hip
• maximum patient satisfaction
• long implant survival

Thus, the “bionic knee” is achieved, which is assimilated as if it were the patient’s own joint and has very long durability.

Patients are informed preoperatively through digital files about their treatment options, review their individualized three-dimensional surgical plan, and after the procedure receive a complete file with details of the method, prosthetic materials, and their certification.

The Clinic has been applying navigation systems since 2011, gaining extensive experience through numerous procedures, participation in Pan-European congresses, and with its Director serving in an educational role for younger surgeons.

Since 2019, a large number of knee and hip procedures have been performed using the Mako robotic system, ranking the Clinic among the top three in Greece and among the leading centres in Europe in terms of successful cases.

Even in cases of early or moderate arthritis, where arthroplasty is not yet indicated, the Clinic offers appropriate solutions based on a specific therapeutic algorithm, selecting individualized treatment strategies for each patient.

Biological therapies approved by the European Medicines Agency (EMA) are applied, including autologous adult stem cells, in collaboration with the Biological Clinic of the Academy of Athens.

Modern treatment options are provided for meniscal tears (repair, meniscal scaffolds, biological therapies, transplantation), minimally invasive techniques for the repair of cruciate ligaments and rotator cuff tears, corrective osteotomies, and cartilage transplantation, all performed with excellent outcomes.

The Director of the Clinic, Dr. Stavros Alevrogiannis, has been certified as a Master Surgeon in Joint Replacement by the Surgical Review Corporation (SRC). This accreditation confirms the excellence of his surgical performance and his commitment to providing the highest level of patient care.