Robotic-Assisted Joint Replacement Surgery Improves Patient Outcomes

Robotics is being increasingly integrated into joint replacement surgeries, although more research is required to understand its benefits. Now, researchers from Hospital for Special Surgery (HSS, New York, NY, USA) have conducted two retrospective studies to assess outcomes in knee and hip replacements performed with robotic assistance.

The first study focused on total knee replacement surgery and examined whether employing a surgical robot during the procedure could reduce the need for manipulation under anesthesia (MUA). MUA is an outpatient process often needed when post-surgery physical therapy becomes excessively painful due to joint stiffness from scar tissue. Typically, around 3.5% of knee replacement patients require MUA, usually within 90 days following their surgery. Post-MUA, patients generally find it easier to engage in physical therapy and advance in recovery. The HSS team aimed to determine if using computer navigation or robotic arm assistance during surgery could reduce the need for MUA. Previous studies have indicated that these technologies can lead to more accurate knee replacements. The HSS study reviewed 21,893 knee replacement surgeries conducted between April 2008 and December 2022 and discovered a significant decline in the need for MUA among patients who had robotic-assisted surgeries (2.7%) and surgeries performed with computer navigation (2.8%), compared to surgeries without these technologies (3.7%).

The second study compared short-term outcomes of anterior and posterior approaches in robotic-assisted total hip replacement (THR) surgeries, focusing on dislocation, re-operation, revision rates, and patient-reported outcomes. With no clear consensus on which approach best reduces postoperative complications, patients often face uncertainty in choosing the appropriate method. The HSS team examined 2,040 consecutive robotic-assisted THRs for osteoarthritis, recorded in the HSS patient registry from 2017 to 2020. Among these, 497 used the anterior approach and 1,542 the posterior approach. With an average follow-up of 18 months, no significant differences were found in rates of dislocation, re-operation, or revision surgery between the two approaches. However, at six weeks post-operation, the anterior approach showed slightly quicker functional recovery, but by three months, the differences in recovery rates between the approaches ceased to be significant.

“We have found that robotic assistance leads to improved implant positioning, alignment and ligament balance, which enable us to better replicate the patient’s natural anatomy,” said David J. Mayman, MD, chief of the Adult Reconstruction and Joint Replacement Service at HSS. "As the use of robotic assistance in joint replacement surgery becomes more common, future studies should evaluate outcomes over longer periods of time.”

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