It is intriguing to think that someday we may be replacing human joints using AI, Augmented Reality, and Robotics. For now, we have to wait for the merits of these technologies to prove their value in joint replacement.

Orthopedic device companies have invested billions of dollars in marketing what they term “robotics” as a means of luring patients who are attracted by the “latest advancements” in joint replacement. Truthfully, after more than 12 years of vigorous promotion, there is very little unbiased clinical data that demonstrates better outcomes with” robotically assisted” hip and knee replacement.



While true robotics has demonstrated its value in other fields (such as DaVinci for prostate surgery), those robots are quite different and are much more sophisticated than any used in joint replacement. “Robots”, such as the Mako, are no more than a machine arm that can be used to make bone cuts. Making bone cuts is, in fact, one of the easiest steps in the operation and is readily mastered by most trainees. While “robotically assisted” bone cuts can be very precise, such precision does not mean that the cuts are always accurate. The following picture demonstrates the difference between precision and accuracy. The box on the bottom left demonstrates that it is possible to be precisely inaccurate.

As merely a machine arm, the “robot” does not recognize and address the many essential steps required to ensure proper stability and balance of the implant. This can lead to worse outcomes if the surgeon is falsely led to believe that the” robotic” plan is correct.
The claim that Mako is less-invasive, less traumatic, safer, accommodates shorter incisions or accelerates healing and rehabilitation is not supported by randomized controlled clinical data. In fact, Mako uses an implant design that is 20 years old and does not have narrow sizes that are essential for some patients. Arrays that allow the “robot” to know where the knee is in space require extra holes to be drilled into the bone sometimes through separate incisions. Mako is more invasive, not less.

Someday, “robotics” may become sufficiently sophisticated to a make positive contribution to the outcome of total joint surgery that justifies the added cost of their use. So far, there is no evidence that “robotically assisted” joint replacement bestows any benefit such as less pain, faster recovery, greater durability or better function. These measures of outcome require a much more comprehensive approach than just the surgery itself.

Less pain, faster recovery and better long-term function result not just from meticulous surgery, but also from close attention to all of the “assets” of the procedure: anesthesia, nursing, education, navigation, and rehabilitation. AVATAR provides the sophistication that “robotics” lacks to wrap all of these assets into a well-navigated care process.

Whom would you trust to do your surgery?

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