Mako vs ROSA vs Navio: Robotic Knee Surgery Compared 2026

Orthopedic Surgery · 2 · July 9, 2025

In 2019, fewer than 8% of US knee replacements used robotic assistance. By 2025, that figure has crossed 34%, according to AAOS data. Three systems compete for dominance: Stryker's MAKO, Zimmer Biomet's ROSA, and Smith+Nephew's NAVIO. Each promises better alignment, less tissue damage, and faster recovery. But do they deliver?

MAKO SmartRobotics (Stryker)

MAKO uses a preoperative CT scan to build a 3D model of the knee. During surgery, the robotic arm provides haptic feedback — it physically resists the surgeon if the saw strays outside the planned bone cuts. Installed at over 1,500 hospitals worldwide, MAKO has the largest evidence base. A 2024 Journal of Arthroplasty study of 5,200 MAKO cases found 97% of implants within 1° of planned alignment, vs. 82% for manual technique.

ROSA Knee System (Zimmer Biomet)

ROSA doesn't require a preoperative CT — it uses intraoperative imaging to map the knee in real time. This reduces cost and preparation time. The trade-off: slightly less precise preoperative planning. A 2023 multicenter study in Clinical Orthopaedics found ROSA produced comparable alignment accuracy to MAKO but with 12 minutes less surgical time on average.

NAVIO (Smith+Nephew)

NAVIO is the smallest and most portable of the three. It's image-free — no CT scan needed. The system tracks the knee using infrared cameras and creates a real-time surface map. NAVIO excels in partial knee replacement, where its precision in preserving healthy bone is particularly valuable. A 2024 Knee Surgery study reported 95% of NAVIO partial replacements achieved optimal component positioning.

Cost Comparison

| Country | Cost Range (Robotic Knee Surgery)

| United States | $45,000–$70,000

| India | $7,000–$9,500

| Turkey | $10,000–$15,000

| Mexico | $15,000–$22,000

Key Takeaways

- All three robotic systems improve alignment accuracy compared to manual surgery — the differences between them are smaller than the gap between robotic and manual.

- MAKO has the largest evidence base and highest precision. ROSA is faster. NAVIO is best for partial knee replacement.

- Robotic knee surgery in India costs $7,000–$9,500 — roughly 85% less than the same robotic procedure in the US.

Compare real-time pricing using our global cost calculator.