Robots in the Operating Room During Hip and Knee Arthroplasty

Abstract

Purpose of the Review The utilization of technology has increased over the last decade across all surgical specialties. Roboticassisted surgery, among the most advanced surgical technology, applied to hip and knee arthroplasty has experienced rapid growth in utilization, surgical applications, and robotic platforms. The goal of this study is to provide a comprehensive review of the most commonly utilized robotic platforms for hip and knee arthroplasty and the most up to date literature on the benefits and limitations of robotic arthroplasty. Recent Findings Studies consistently demonstrate that that robotic-assisted surgery during total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) improves component position and alignment. There is also growing evidence that robotic-assisted UKA improves clinical outcomes and implant survivorship and, therefore, may be cost-effective. However, there remains to be convincing evidence that robotic-assisted arthroplasty improves clinical outcome measures or reduces revision rates for THA and TKA. Potential disadvantages of robotic arthroplasty remain, including a learning curve, potential for additional radiation exposure preoperatively, and the financial costs. Summary Robotic hip and knee arthroplasty remains attactive as studies show that it consistently improves implant position and alignment over conventional techniques. There is growing evidence that robotic UKA may improve patient outcomes and reduce revision rates, but further study is needed. In addition, further and longer-term studies are needed to determine if improved component position and alignment in TKA and THA leads to improved clinical outcomes and reduced revision rates. Keywords Total hip replacement . Total knee replacement . Unicompartmental knee replacement . Robotics . Clinical outcomes . Implant alignment This article is part of the Topical Collection on The Use of Technology in Orthopaedic Surgery-Intraoperative and Post-Operative Management

Robotic Total Knee Arthroplasty vs Conventional Total Knee Arthroplasty: A Nationwide Database Study

“…Several studies have shown improved accuracy in implant positioning and limb alignment with the use of robotic arms in TKA procedures [ [25] , [26] , [27] , [28] , [29] , [30] ]. However, potential concerns associated with using robotic arms for TKA include increased costs, increased surgical time, and no guarantee of improved accuracy or decreased postoperative complications [ [30] , [31] , [32] , [33] ]. Despite contrasting views and evidence in regard to robotics in TKA, utilization of robot arm–assisted TKA has been rapidly growing, with a reported 6.8% increase in usage between 2005 and 2014 [ 34 ].…”

Advances and innovations in total hip arthroplasty

“…Moreover, there are still several limitations of robotic THA: installation costs, additional radiation exposure, learning curve, and the compatibility of the robotic systems with a limited number of implants [ 48 ]. While there is growing evidence that robotic-assisted UKA may improve clinical outcomes and implant survivorship [ 31 , 37 , 49 ], recent reviews and meta-analyses encompassing patients undergoing robotic-assisted THA reach a similar previous conclusion [ 50 – 54 ]. Whether semi-active or fully-active robotic systems are effective in improving postoperative pain, quality of life, and satisfaction following THA is unclear; thus further research is needed to determine if better outcomes and improved implant longevity could justify increased costs.…”

The current state of robotics in total knee arthroplasty

“…As long-term outcomes become clearer, surgeons will need to decide whether the risks and benefits of adopting such technology outweigh those associated with the freedom of implant choice. 31 , 32 …”