Ask a Doctor: Dr. Simon Amsdell, Orthopedic Surgeon

The use of a surgical robot has gained widespread acceptance for the fields of gynecology, urology and some general surgical procedures.  The surgical robot allows the surgeon to be in the operative room away from the patient, utilizing controls to guide the robotic arms to do a procedure where visualization may be difficult.  In orthopedics, various types of robots have been designed to assist in the guidance of bone cuts and the placement of implants.  The surgeon is still performing the procedure, with the guidance of a robotic arm.  This is compared to conventional knee replacement where alignment guides and surgeon experience allow accurate placement of implants. 

A common misconception is that robotic knee replacement is less invasive than traditional instruments.  This is inaccurate, the same superficial and deep incisions are made as with conventional instruments.   Robotic surgery is more expensive to perform as there are elevated costs to purchase and use robotic guidance and most systems require advanced imaging (CT vs MRI) to be performed prior to surgery.  Another common myth is that robotic surgery in orthopedics will lead to a faster recovery.  There is no strong data to support this. 

Robotic surgery was designed for use in our field to optimize the accuracy of implant placement over historical methods.  We do not have any strong data at this time that using robotic guidance changes or improves outcomes, or lowers risk in orthopedic surgery.   The AAOS (American Academy of Orthopedic Surgery) current stance is: SURGICAL NAVIGATION- There is no difference in outcomes, function, or pain between navigation and conventional techniques. Quality of Evidence: High

ROBOTICS IN TOTAL KNEE ARTHROPLASTY Evidence suggests no significant difference in function, outcomes, or complications in the short term between robotic assisted and conventional total knee arthroplasty (TKA). Quality of Evidence: High

Personally, I perform conventional total knee replacement and rely on robust surgical training in these techniques.  I find that it is lower cost, efficient and provides similar outcomes to the use of robot navigation.  Individual reasons to utilize robotic navigation among surgeons may depend on their training, experience or local marketing trends, but does not appear to influence outcome.