Merits and Limitations of Robotic-assisted Surgery in Improving Precision, Accuracy, and Patient Outcomes in Orthopedic Procedures

Author(s): David Parvizi, Blake Han, Artin Allahverdian, Devendra K Agrawal

Since the 1980s, research in robotic-assisted orthopedic surgery has shown to improve precision and accuracy in implant positioning and alignment, specifically for knee and hip arthroplasty. The current meta-analyses and randomized controlled trials have shown that robotic systems are able to consistently reduce alignment outliers and lead to improved radiological outcomes. Some evidence has also concluded small, yet significant, improvements for short-term, patient-reported postoperative pain. Although modest improvements have been demonstrated in the shortterm, long-term technical improvements have not been established. Patient satisfaction, functional outcomes, and rates of revision and complications are still under investigation in terms of long-term outcomes. Moreover, clinical impact is also variable between different robotic platforms, surgeon experience, and healthcare setting. High costs, steep learning curves, and increased operative costs are major limitations to the implementation of widespread use of robotic systems. Altogether, robotic-assisted orthopedic surgery may improve technical accuracy and precision, however, its limitations such as inconsistent clinical benefit, increased operating time, and high cost begs the question whether these systems will be implemented in hospital systems. Further long-term studies must be done to conclude whether robotic assistance plays a significant role in improving clinical outcomes.