Technology has evolved orthopedic surgery just like it has other industries. The reproducible nature of hip and knee replacement lends itself toward technology that provides for more efficient surgery and better results. I have been actively involved in the advancement of joint replacement technology my entire career. It is a fun and exciting part of my job that keeps me engaged, at the forefront of modern technology, and interacting with bright surgeons and engineers. There are many separate technologies we use and continue to develop in hip and knee replacement. This post will focus on robotics. “Robot” seems to range in our world from a machine that can vacuum your floor to a future humanoid fueled by AI that could take over the planet. What do they do for us in knee and hip replacement? Let me explain their history and utility.
Multiple robotic platforms exist to assist us in surgery. Most of these are company specific, ie the company that sells us the implant has made the investment to develop a robot for use surgically, which most commonly can only be used with their specific implants.
What do robots do?
Traditional joint replacement relies on precise manual instrumentation to allow us to plan and make the cuts necessary to contour bone for positioning joint replacement components. Robotics incorporate navigational technology to assist us in making these cuts. It makes sense to most people that these COULD allow us better surgical precision, but to date most studies show no difference in patient outcomes with robotic surgery. Therefore, the real objective and factual truth is that we don’t have much evidence that using a robot is better for you.
So why use a robot?
Surgeons will give many different answers to this question. I think most of us would agree that better precision MIGHT allow for better outcomes, and that with future iterations of robotics, that this improvement could accelerate. That is my view of robot-assisted surgery. Also, high volume surgeons like me perform hundreds of surgeries a year and about 20 a week. Robots may help save our bodies from the physical work involved. In addition, I’ve devoted my career to knee and hip replacement. After thousands of surgeries, the technological aspects of surgery become interesting forays into making our great surgeries even better. Most industries see robotics improving their outcomes either through efficiency or outcome. We suspect it will do the same, some day, for joint replacement. For these reasons, I currently use robotics for some knee replacements.
Many misconceptions about robotics exist.
- In some surgery cases, like prostatectomy, the robot actually is manipulated by the surgeon at a console away from the surgical site. This is not currently the case for joint replacement. Almost all robotic joint replacement systems have us physically prepare bone at the surgical site. The robotic assist just helps with the location of the bone cuts. We are still manually performing the surgery at the bedside.
- Most robotic talk around knee and hip replacement focuses on knee replacement. This is really because currently we think robots have much more utility for knees. The knee is a more complex joint with multiple aspects requiring bone contouring. Robotic development and use has therefore mostly focused on knees. Some day, robotic advancements will likely make them more useful for hip replacement, but this could take on a different form of technology. Most of us believe that virtual reality will eventually be a useful technology in the hip world. This is an exciting and developing field, but really is in its infancy at this point.
The jury really is out on robotics for knee and hip replacement. All technology should help make your outcome better. At this point there is not much evidence that robotics definitively improve outcome, but we think that day is near, and I plan on staying on top of valuable emerging technology in my field.
