Position Statement regarding Robotic-assisted Hip
and Knee Replacement Surgery
Orthopaedic surgeons are continually striving to improve outcomes for patients requiring joint replacement surgery. Recently there has been interest in using robotic techniques with this aim.
All hip and knee replacement surgery require the creation of an operative plan, and a means of executing that plan. Historically, mechanical alignment instruments were (and indeed still are) used successfully to prepare the bone for the joint replacement prostheses. An alternative technique that was first introduced and reported in the late 1990s is Computer Assisted Surgery (CAS), otherwise known as Computer Navigation, which uses computer-generated images and novel orientation methods to guide surgeons for bone preparation. In the early 2000’s Patient Specific Guides, (image-derived, customised single-use alignment and cutting guides), were developed as another means of achieving accurate bone preparation.
Robotic technologies have been developed with the aim of improving surgical precision, component alignment and soft-tissue balance. The expectation is that this improvement will result in better patient outcomes. Robotic-assisted Joint Replacement surgery includes a preoperative plan developed from radiological images, the use of computer-assisted orientation for positioning (based on Computer Navigation), and the use of robotic-assisted cutting, burring or reaming tools for bone preparation.
While both robotic-assisted joint replacement surgery has been met with optimism, it will take some time to obtain the necessary scientific data to be able to clearly outline its role, and it may be many years before the possible benefits of improved alignment and balance are realised. Importantly, this technology comes with added costs and a potential for increased operating time.
There AOANJRR has recorded encouraging 2-year results for robotic-assisted partial knee replacement. As robotic-assisted total knee and hip replacement has only recently been introduced, results for this technology in these scenarios are not yet known.
All new technologies and techniques require ongoing review and continual assessment of outcomes before a definitive role can be established for them. There is currently insufficient evidence to show that Robotic-Assisted Surgery delivers better outcomes for either Hip or Total Knee Replacement.
This statement is an expression of policy of the Arthroplasty Society of Australia, made in consultation with, and supported by, the Australian Knee Society. It is not a comprehensive review of the subject, nor is it intended as medical advice for the treatment of individual patients.