Principal Director & Unit Head, Orthopaedics, Fortis Memorial Research Institute, Gurgaon
Part 4 of 9 in Recent Advances in Joint Replacement
How Robotic Surgery Is Changing Joint Replacement
April 13, 2025
Dr. Jangid's centre uses what he described as the world's most advanced joint replacement robot, the only system currently offering partial knee, total knee and hip replacement on a single platform, and the only one with haptic control, technology that physically stops the surgeon's instrument from moving beyond a planned safety boundary.
Two rules govern how the robot is used
Dr. Jangid framed the robot's role around two guiding principles: it must never injure the person operating it or being operated on, and it must never act on its own, only carrying out the movements the surgeon directs. In practice, this means the robot assists and constrains the surgeon's own hands rather than operating independently.
Planning starts before the incision
Every robotic case begins with a CT scan, which builds an accurate three-dimensional model of the patient's own bone and joint anatomy. During surgery, the surgical team maps 40 reference points on the femur and 40 on the tibia to match the patient's actual anatomy to that CT model, with the system rejecting any mismatch greater than half a millimetre. From there, the surgeon can plan the correction of deformity, seen in one example as a 13 degree deformity brought down to zero, along with the implant's exact rotation, flexion and extension in three dimensions, before a single cut is made.
The cut itself is constrained in real time
During the operation, tracking markers register the robotic arm's position in space continuously, and the system displays the planned cut in real time. The robotic arm will not move the cutting instrument beyond the boundary set during planning, physically protecting the soft tissue around the joint. Dr. Jangid showed cases where this translated directly into outcomes: full range of motion and a well-matched implant immediately after surgery, and patients walking unaided by the second day after their operation.
This article is based on a Jivo Masterclass session conducted by Dr. Subhash Jangid, Senior Director, Orthopaedics & Joint Reconstruction, Fortis Memorial Research Institute, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Subhash Jangid taught doctors across Africa on April 13, 2025.
FROM THE LIVE Q&A
Doctor on the call (name unclear from transcript)
Is there an age limit for hip or knee replacement surgery?
Dr. Subhash Jangid
There is no fixed age limit at either end. Hip replacement is generally offered from skeletal maturity onward if the joint is badly damaged, and partial knee replacement is usually done from around age 40, occasionally as early as 30, though most patients present between 45 and 50. Modern implants can last more than 30 years, so age by itself is not the deciding factor.
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Frequently Asked Questions
Could an 80-year-old patient with a knee fracture still be considered a candidate for joint replacement surgery?▼
Yes. Age alone should never be the reason to deny treatment. What matters is whether the patient is physiologically fit and medically able to tolerate surgery, not their chronological age. Every patient deserves the chance to keep leading an active life, fracture or not.
Most post-operative painkillers are known to affect the liver. What pain medication is recommended after joint replacement that avoids this?▼
Opioids are used at a very low dose, delivered through a transdermal skin patch or a nasal spray rather than as tablets or injections, giving good pain control without sedation, headache or nausea. Alongside this, the only oral tablet used is paracetamol, which does not affect the stomach or the kidneys.
Sharing an update: how valuable has attending these weekly sessions been?▼
The attendee said he joins every Sunday and is never disappointed, describing the sessions as consistently insightful and helpful for improving his own practice. He mentioned he had further questions and would send them on separately to be passed along to Dr. Jangid.
Could the presentation be shared as a PDF in French as well as English, and was a translator available for the French-speaking doctors on the call?▼
Yes to both. The English PDF was shared with the group, the French version had already been sent separately, and a dedicated French translator was present throughout the session to help the doctors from Congo follow along.
Could the presentation be shared as an English-language PDF?▼
Yes, the English PDF was shared again on request.
What makes this robotic system different from other joint replacement technology?▼
It is the only system Dr. Jangid described that offers partial knee, total knee and hip replacement together, and the only one with haptic control, which physically prevents the cutting instrument from moving past a pre-planned safety boundary.
How accurate is the robotic mapping process during surgery?▼
The system maps 40 points on the femur and 40 on the tibia against the patient's CT scan, and will not proceed if the mismatch between the plan and the patient's actual anatomy is greater than half a millimetre.
In This Series: Recent Advances in Joint Replacement
- 1.Recent Advances in Joint Replacement
- 2.Who Needs a Knee or Hip Replacement: Symptoms and Warning Signs
- 3.Partial or Total Knee Replacement: Matching the Procedure to the Patient
- 4.How Robotic Surgery Is Changing Joint Replacement
- 5.Hip Replacement Surgery: Implant Design, Materials and Durability
- 6.When Joint Replacement Surgery Should Be Delayed or Avoided
- 7.Correcting Severe and Bilateral Knee Deformities
- 8.Recovery, Pain Management and Rehabilitation After Joint Replacement
- 9.Joint Replacement Surgery in India: What International Patients Should Know