Robotic surgery: Breakthrough for arthritis pain

She sounds calm, happy and relieved. For the first time in 15 years, 59-year-old Christine Musonye Mugalisi speaks without the heaviness of pain weighing down every sentence. There is laughter between her words and an unmistakable sense of freedom.

“For 15 years, I was in pain,” she says. “My knees used to ache so much. I could not walk well. I was in so much pain.

According to the World Health Organisation, osteoarthritis is a degenerative joint disease that causes pain, swelling and stiffness, affecting a person’s ability to move freely.

It affects the entire joint, including the tissues around it and is most common in the knees, hips, spine and hands. Several factors contribute to the development of osteoarthritis, including joint injuries or overuse, ageing and excess weight. The condition affects women more than men

Globally, about 60 per cent of people living with osteoarthritis are women and roughly 70 per cent are over the age of 55.

As populations age, the prevalence of osteoarthritis is expected to rise significantly. Globally, it is one of the leading causes of years lived with disability among musculoskeletal disorders.

For Christine, the diagnosis was devastating. For more than a decade, she managed the condition with painkillers, but as it worsened, doctors advised that knee replacement surgery was the only viable option.

She initially sought care at a hospital in Lang’ata before being referred to Metropolitan Hospital for specialised treatment. There, doctors introduced her to an option she had never heard of before — robotic-assisted knee replacement surgery. “They told me the robot only shows where the damage is in my knee,” Christine recalls. “It helps the doctor see clearly and cut only what is necessary. The robot does not operate on its own.”

The term “robotic surgery” often brings to mind images of machines performing procedures independently. In reality, robotic-assisted surgery is entirely controlled by highly trained surgeons.

The system does not replace the doctor; instead, it enhances precision through detailed imaging, virtual planning, and guided bone cuts.

“At first, I was very worried,” Christine says. “Even my family feared it might damage my knees. We didn’t understand how a robot could operate on someone.”

High cost

The cost, however, came as a shock. “I was worried about how my family would manage. It was expensive,” Christine admits. “We decided to fundraise because I was in so much pain. It took about three days, and I don’t remember exactly how much my siblings contributed, but they covered it.”

After several consultations and reassurances, she agreed to go ahead with the procedure. “If they had told me to go with the conventional surgery, I would still have agreed,” she says. “I just wanted the pain to stop.”

Christine underwent the surgery on February 4, 2026. “I was able to walk after a week,” she says. “Right now, I am under medication, taking painkillers. There’s little pain compared to before the surgery. The doctor advised me not to walk long distances. The surgery has really improved my life. The pain is no longer there.”

Her sister, Gloria Ondisa, 43, shared the impact on their family. “Christine is my big sister, and before the surgery, life was very difficult for her. She could barely walk and was in constant pain. We had to make many sacrifices because we don’t have much money, and our sister is a widow with no husband to support her. We had to fundraise for the surgery. It wasn’t easy—some people said they couldn’t help, so my brother and I took loans to cover the costs.”

Gloria highlighted the difference between conventional and robotic surgery. “Four years ago, my sister had conventional knee surgery on her left leg, and it did not heal well. The pain she feels now is just from the small wound healing. She was even advised not to ride motorbikes. Only one leg had conventional surgery, while the other underwent robotic knee surgery, and it healed quickly. After the first surgery, we had to carry her to the hospital despite the operation. This time, with robotic surgery, her recovery was much faster.”

She adds, “We were introduced to this by Dr Faraj Alkizim, an orthopaedic and spine surgeon and Head of Robotics, Joint Replacement and Spine Surgery at Metropolitan Hospital.

Dr Faraj explains why robotic knee replacement differs from conventional surgery.

“Robotic knee replacement offers improved planning, predictability and precision,” he says. “In conventional surgery, planning is largely based on X-rays. With robotic-assisted surgery, patients first undergo a full CT scan from the hip to the foot. This allows us to study the entire alignment of the limb. The images are then uploaded into specialised software where the procedure is performed virtually before entering the operating theatre. You are basically doing the surgery on a computer first.”

Dr Alkizim explains that during the operation, the robotic arm assists the surgeon in making bone cuts with sub-millimetre and sub-degree accuracy.

Better alignment

Unlike free-hand cutting with an oscillating saw, the robot operates within predefined safety margins and does not cut beyond the bone, protecting surrounding soft tissues.

Even slight changes in alignment can affect how weight is distributed. Precision matters for long-term function.”

Better alignment, he says, reduces uneven wear of the implant, lowers the risk of loosening and may reduce the need for costly revision surgeries later.

He clarified that not everyone with arthritis requires knee replacement. “Arthritis ranges from mild to severe. Mild arthritis can be managed with medication, physiotherapy, lifestyle changes, and weight loss. We only consider joint replacement when it is severe and affecting daily living.

The decision is made jointly between surgeon and patient, based on X-ray findings and how much the condition disrupts quality of life.”

Most patients who qualify for conventional knee replacement also qualify for robotic surgery. However, certain cases—such as extremely soft bones, severely distorted anatomy from previous surgeries or infections, or joints requiring specialised implants—may not be suitable.

Although the robotic system was installed in December 2025, early results are promising. “So far, we have done two cases,” Dr Alkizim says. “One patient walked immediately after surgery without a walking aid. Another patient who had one conventional knee replacement two years ago reports that the robotic side healed faster and had less postoperative pain.”

Typically, wound healing takes one to two weeks and most patients recover within four to six weeks, though recovery varies individually. Robotic knee replacement currently costs slightly above Sh700,000 at Metropolitan Hospital, making it more expensive than conventional surgery in many facilities. The added cost covers the robotic technology, additional consumables and pre-operative CT scanning.

“At present, SHA and many insurance providers cover joint replacement generally, though additional robotic costs may require out-of-pocket payment,” Dr Alkizim explains.

“We are bridging the gap. Patients no longer have to bear the costs of visas, flights and accommodation abroad. Already, we are seeing patients who didn’t come specifically for robotic surgery—they came for a consultation and I offered them the robotic option. We attract patients from all over and there is a growing demand for precision across all sectors. Not just in medicine, but across industries, people are striving to do things better. In healthcare, all specialties are aiming for higher standards. We perform high-volume joint replacements, and robotic surgery allows us to do them better.”

With time, he adds, awareness will grow.“According to information from India, they receive many patients from Kenya who travel there specifically for robotic surgery. We are essentially bringing world-class care home, making it more affordable. Traveling abroad involves many costs—visa, insurance, flights, accommodation—and the opportunity cost for caregivers escorting the patient. Here, insurance often helps cover the procedure, unless you have international insurance.”

The doctor emphasises that robotic surgery is only an assistive tool. “It is robotic-assisted surgery, not robotic surgery. The surgeon remains fully in control throughout. The system only aids in the more delicate parts of the procedure, such as bone cuts, which can affect the outcome. Patients should not think a robot is performing the surgery on its own.”

He also highlights the potential for expansion. “While it is more developed in joint replacements, especially knees, we have robotic hip replacement and the robot can be upgraded. In future, it could do spine surgery and trauma surgery. Robotics is improving, just like AI. It provides real-time feedback during surgery—alignment, angle, balance, stability—which we could not measure as accurately before.”

Metropolitan Hospital, he adds, is committed to innovation. “We are pursuing advancements to enhance patient care and aim to become a center of excellence in surgery and healthcare. I am privileged to have been part of this journey and to have performed the first robotic surgery in the country and the region.”

Arthritis is becoming increasingly common in Kenya. In 2022, orthopaedic surgeons at Nairobi Hospital’s Physical Medicine and Rehabilitation Centre warned that an estimated 9 million Kenyans—about 18 per cent of the population—are at risk of permanent disability. Once considered a condition of old age, osteoarthritis now affects people under 30, with physiotherapists attributing the rise to sedentary urban lifestyles.

About 60 per cent of Kenyans over 40 are at risk of disability, while 5–10 per cent of younger adults are also affected. The knee, hip, hand, and spine are the joints most commonly impacted. Additional risk factors include excessive alcohol and tobacco use, occupational hazards, and the presence of multiple non-communicable diseases. Globally, around 10 per cent of people over 60 experience symptomatic osteoarthritis.

In Kenya, the Kenya National Bureau of Statistics (KNBS) 2020 report recorded 1.8 million cases of arthritis, with Meru, Murang’a and Nyeri counties reporting the highest numbers. Other counties with significant cases included Nairobi, Makueni, Kiambu, Kirinyaga and Tharaka Nithi, while Lamu, Garissa and Tana River reported the fewest. This growing burden underscores the importance of accessible treatment.

For patients like Christine, robotic surgery has been life-changing. “When I look back, the surgery really saved my life. I can only advise other Kenyans suffering from arthritis to go for this surgery. One heals fast; they should just go to the hospital and get it done.”

Metropolitan Hospital, Nairobi, in partnership with India’s Marengo Asia Hospitals, performed the first robotic-assisted knee replacements in East and Central Africa on December 10, 2025. The collaboration strengthens local skills in precision orthopaedic surgery.

Dr Kanyenje Gakombe, CEO of Metropolitan Hospital, says, “This milestone brings world-class robotic surgery to Kenya, giving patients safer, faster, and more precise care.”