How robots are transforming joint replacement surgery

Written by: Mr Ian Holloway
Edited by: Laura Burgess

What is a robotic joint replacement?

A robotic joint replacement, or more accurately robotic-assisted joint replacement, is a recent technological advance in orthopaedic surgery. The surgeon performs the joint replacement surgery with the assistance of a robotic system to improve implant positioning and soft tissue balance.

This is achieved by enhanced, computerised pre-operative planning and detailed 3-dimensional intraoperative data collection about the individual patient's anatomy
. The data is then analysed by a computer and the computerised model is used by the robot to help the surgeon achieve very accurate bone preparation. This gives the best postoperative alignment, balance and restoration of the anatomy.

What are the different types of robotic joint replacement?

There are 2 main types of robotic joint replacement surgery. The first uses a robotic arm, which locks into the correct position, and allows accurate bone preparation through haptic control - the robotic arm will not allow the bone saw to be moved into an inappropriate position. The second system uses a computer-controlled burr to prepare the bone surfaces. The burr cuts-out if it is moved into an area where bone does not need to be removed.


What is the recovery time for robotic (knee) surgery?

The recovery time for robotic controlled joint replacement surgery is quicker than with conventional surgery. Recent research has shown that robotic guided knee replacement is associated with reduced postoperative pain, lower requirements for analgesia (pain control medication) and shorter hospital length of stay compared to conventional knee replacement.


Is this technology the future of surgery?

Robotic guided surgery is an attractive technique for other reasons. For hip replacement, implant position has been shown to be more accurate with robotic guided surgery. There are also reports to show similar findings for knee replacement. Whilst we do not have data to show that these benefits will translate into improved implant survival or long-term satisfaction, we know that implant position has a bearing on these outcomes. There also seems to be a lower risk of inadvertent soft tissue injury with robotic guided joint replacement compared to conventional joint replacement.


What are the advantages/disadvantages of a robotic joint replacement?

The reason for the development of the robotic systems is to try to improve outcomes for patients. Hip and knee replacement are very successful procedures but there are around 10% dissatisfied patients after hip replacement and 20% dissatisfied patients after knee replacement. It is hoped that with more accurate implant positioning, and with the improved soft tissue balance (avoiding tissues being too tight or too lax), that satisfaction levels will improve further.

The main disadvantage of the robotic system is the cost to the healthcare provider. Also, the robotic procedure takes a little longer, and one of the systems does need a pre-operative CT scan to be performed.

Mr Ian Holloway

By Mr Ian Holloway
Orthopaedic surgery

Mr Ian Holloway is a leading consultant orthopaedic surgeon in London, who specialises in hip and knee replacement surgery. He trained in London and was a senior trainee at the Royal National Orthopaedic Hospital.

Mr Holloway completed two specialist hip and knee fellowships in Sydney and Melbourne, Australia. He undertakes revision hip replacement for cases with significant bone loss and for periprosthetic fractures. He built his experience on the Bone Tumour Unit at Stanmore and treats patients with metastatic bone disease with an emphasis on early symptom control and aggressive rehabilitation.

Mr Holloway is a national and international speaker on enhanced recovery after hip and knee replacement. He has publications in the medical literature on hip and knee surgery and is also on the teaching faculty of a number of orthopaedic training courses. 

He is Deputy Training Programme Director for higher surgical trainees in the North West Thames region and is Clinical Lead for orthopaedics at the London North West Healthcare NHS Trust. He is a reviewer for the Bone and Joint Journal.

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