Robotic-Assisted Revision Total Knee Arthroplasty for Minimal Bone Loss: A Step-by-Step Surgical Technique

Background: Revision total knee arthroplasty (rTKA) is a technically demanding procedure that, when performed using mechanically aligned strategies, frequently relies on stems, augments, metaphyseal cones and constrained implants to restore knee alignment and stability. In carefully selected cases with preserved metaphyseal bone stock and competent collateral ligaments, robotic assistance allows a bone-preserving strategy in which alignment, joint line height, and soft-tissue balance are restored using conventional posterior-stabilized components with short cemented stems rather than higher invasive and constrained constructs. Methods: This technical note describes a step-by-step surgical workflow using the Mako robotic system (Stryker) to revise failed primary TKA associated with minimal metaphyseal bone loss to rTKA with conventional posterior-stabilized components and short cemented stems within a functional alignment framework. Results: The workflow integrates CT-based three-dimensional planning, registration on in situ implants, real-time gap assessment, and precise robotic bone preparation to correct deformity and to restore stability while minimizing additional bone resection. In this setting, limited tibial metaphyseal defects are managed with impacted autologous cancellous graft, and stable fixation is achieved with short cemented stems. Conclusions: This robotic-assisted approach is intended as a bone-preserving option for selected rTKA cases associated with minimal bone loss and as a conceptual bridge between robotic-assisted primary and conventional revision TKAs performed with mechanical techniques and alignments.