A raging debate has entered the orthopaedic hip and knee replacement world that draws the ire of many surgeons. Total Joint Replacement with the assistance of a robot. The discussion draws such visceral responses that I have personally witnessed surgeons walk out of rooms when the topic is broached. The surgeons who embrace the traditional, or manual approach, to joint replacement will argue that they have great results and why should they compromise their outcomes to attempt a new technology. The sentiment is certainly understandable: learning curve, time, cost, etc. However, I believe these surgeons need to account for the reproducibility of the robot to better position the components more consistently. If I want to set the acetabular component on a hip replacement (the cup) to 40 degrees of abduction and 20 degrees of anteversion we know a robot will do this more consistently and accurately than the world’s best surgeon. Why? Because robots are more accurate than humans. Why compromise? Certainly, nothing will supplant great surgical technique and meticulous dissection in the operating room. But if we can increase the reproducibility and accuracy, then why not?
The same holds true for total knee replacements. The thought is the robot can consistently and more accurately balance the knee in both flexion and extension. We can set the templated alignment and resection to within 1 degree and 0.5 millimeters prior to making a cut--within a defined field and the aid of a robotic arm. We can minimize the soft tissue releases and canal violation to help minimize postoperative pain and blood loss. The older literature will argue there is no difference when compared to the manual approach. However, this data is changing. More studies are beginning to be published, and are in process, that indeed show that postoperative pain and outcomes are different with the use of the robot. As the technology continues to evolve, we can continue to learn from our experiences with robotic joint replacement to better refine the future of joint replacement. This is no longer simply a technological fad or marketing effort that will fade. We will be able to continue to collect massive amounts of data to better improve the current technology for ultimately the patient’s benefit. As the technology becomes more commonplace the costs of such technology will decrease and should the revision rates of joint replacement decrease as a result of the technology this will further decrease cost.
At Ortho Rhode Island we are consistently on the cutting edge of technology and nowhere else is this more evident than in robotic joint replacement. Our dedicated, subspecialized surgeons consistently are looking to better improve the accuracy of our surgeries in an ultimate effort to better what matters most: the patient experience.