As one of the only private hospitals in Gloucestershire offering robotic-assisted joint replacement surgery, Nuffield Health Cheltenham Hospital is combining expert surgical skill with cutting-edge technology to deliver more precise, personalised procedures that improve patient outcomes and speed up recovery times.
SoGlos sits down with Mr Navraj Atwal, an orthopaedic surgeon with over 25 years of experience, to find out how robotic-assisted surgery is reshaping knee replacements for both patients and surgeons.
Tell us about your background and how you came to work with robotics.
Very early in my training, I realised I loved knee surgery. It's a complex joint and getting it right can be challenging. Historically, the literature states that up to one in five patients hasn't been fully satisfied with their knee replacement.
That’s what drew me to robotics. It offers an additional level of precision — something particularly valuable when dealing with such a complex joint.
I had already been using surgical technology during my time working in Sydney, Australia, where navigation systems were widely used. Robotics is the natural evolution of that.
After 25 years as an orthopaedic surgeon, I know what good outcomes look like. Robotics helps me deliver that level of precision consistently.
How does robotic-assisted joint replacement differ from a standard knee replacement?
Traditionally, knee replacements are performed using manual instruments. While these are highly refined, factors like anatomical variation or slight movement during surgery can affect accuracy.
The beauty of robotics is that it is precise within 0.5 of a millimetre.
Before surgery, we map the joint in detail. The system we have at the Nuffield is imageless, meaning it doesn’t rely on CT or MRI scans, which have radiation involved. Instead, it builds a real-time, highly accurate model based entirely on the patient’s anatomy.
By manipulating the patient’s leg, the system creates a personalised 3D model of the joint. From there, I can plan and fine-tune every aspect of the procedure — even determining the optimal positioning of the joint based on soft tissue balance.
Once the plan is set, the surgery proceeds as normal — but with the added benefit of robotic guidance. The surgeon remains fully in control at all times, using the system to check and refine each step for maximum accuracy.
It doesn’t replace surgical expertise, it enhances it.
So, you have full control of the robot at all times?
Absolutely. The surgeon is always in control of both the robotic arm and the data guiding it.
I’m physically holding and guiding the robot
throughout the procedure. I can stop at any point, reassess, or switch to
conventional instruments if needed.
It’s a tool, not a replacement for judgement.
What is it like for you as a surgeon to transition to this way of working?
It builds on everything I’ve learned over the past 25 years. What robotics allows you to do is refine the outcome even further. It’s made me think more deeply about every aspect of knee replacement surgery, because you can personalise the procedure so precisely to each patient and their individual anatomy.
The data is incredibly powerful. You can assess joint movement in real time and immediately see how changes will affect the final result – and what the patient should be able to achieve after the surgery.
That level of feedback is hugely empowering as a
surgeon.
What are the main benefits of robotic-assisted joint replacement for patients?
For patients, the biggest benefit is accuracy. The joint can be positioned more precisely, which helps optimise movement and function from the outset.
There are also practical advantages. Because the procedure avoids entering the medullary canal of the bone, there is typically less bleeding.
Many patients also recover more quickly in the early stages. While recovery always varies from person to person, we often see improved joint function within the first few days — helping patients get up, moving, and back to their normal environment sooner.
Is robotic‑assisted joint replacement suitable for everyone?
From a surgical point of view, it can be used in
the vast majority of cases.
In fact, it can be particularly valuable for patients with more complex anatomy, such as those with previous injuries or operations where conventional instruments may be more limited.
The ability to adapt in real time makes it an extremely versatile tool.
Do you think robotics is the future of all surgeries?
We’re living in a digital world and technology
is advancing rapidly — mostly for the benefit of patients.
If you think about how far we’ve come, from putting coins into phone boxes to smartphones, it’s clear that innovation becomes part of everyday
life. Surgery is no different.
Robotics will continue to evolve, becoming more
streamlined, more accessible, and more widely used.
But one thing won’t change – technology can enhance surgery, but it will never replace the judgement and experience of a skilled surgeon.
To book a consultation with Mr Atwal, visit nuffieldhealth.com/consultants/mr-navraj-atwal.
