Are robots the future of knee replacements?

Robots may be more efficient, but they're also much more expensive.

Maija Kappler 3 minute read November 19, 2021
Low polygonal human and robot hands

The most commonly-cited reason for using robots was to increase surgical precision. GETTY

Would you have surgery performed by a robot?

Believe it or not, robot-assisted surgery is a flourishing field. It’s used primarily for minimally-invasive procedures where the only incisions made are small ones. Surgeons insert miniature instruments and cameras, which they can then control remotely. The cameras allow doctors to get better visuals of the area they’re operating on, and the instruments give them more access with fewer (or smaller) incisions. Robot-assisted surgeries usually involve less blood, and patients experience less pain and have shorter hospital stays.

“The robot is never, ever making decisions or performing incisions,” UCLA Health’s website assures patients. “Rather, your surgeon is telling the robot what to do, and the robot allows for greater precision than the human hand on its own.”

A recent study from the Hospital for Special Surgery in New York suggests that robotic-assisted knee replacement surgery has led to a lower complication rate in the first three months post-procedure. “The use of computer-assisted navigation and robotic assistance for total knee replacement has increased tremendously and shows no sign of slowing down,” said Dr. Geoffrey Westrich, one of the authors of the study, which was published in the journal Arthroplasty Today.

The study looked at more than 1.3 million patients who had total knee replacements between 2010 and 2018. It found that 1.57 per cent of the patients who had robotic-assisted surgery had complications that made them return to a hospital within a 90-day period, compared to 2.55 per cent of patients who had conventional surgery.

“The data imply that for every 102 patients treated with robotic-assisted knee replacement, one readmission may be avoided,” Westrich said.

During a 2020 meeting of the American Association of Hip and Knee Surgeons, the most commonly-cited reason for using robots was to increase surgical precision, he added.

Robot-assisted surgery started in the U.S. around 2000, according to CBC News.  Canada adopted the practice a few years later, with the approval of the da Vinci Surgical System, a robot that allows the surgeon to operate three or four surgical arms. In 2017 there were 31 across Canada, according to The Globe and Mail. St. Joseph’s Healthcare in Hamilton, Ont. also has  Canada’s only orthopaedic surgical robot, the MAKO Rio. Its first surgery, performed on a 66-year-old man in 2019, was a knee replacement.

These technologies aren’t cheap: St. Joseph’s was able to buy the robots after receiving $10 million in donations, and each surgery performed with a robot is about $3,000 more expensive than in conventional procedures.

Not everyone is a fan, though. As The Globe and Mail reported in 2017, the Ontario Health Technology Advisory Committee (the expert group that advises the province on the funding of health services and devices) ruled that the benefits of robot-assisted surgery weren’t significant enough to justify the cost. The ruling was a controversial one: five doctors involved were so opposed to the conclusion that they asked for their names to be removed.