Robotic Knee and Hip Replacement Marketing Myths

MACO Robot

Recently, our health system's cost/outcomes data showed that robotic total knee (RTKA) had greater per case cost than manual (MTKA), with minimal differences in hospital lengths of stay, complications and patient outcomes. 

As a fellowship trained member of American Academy of Hip and Knee Surgeons (AAHKS), I have been trained on various robotic and navigation systems.  My experience with robotic technology in private practice is similar to the majority of evidence presented at the academy meeting this year.  This year's papers again showed increased time and cost without significant return in function and outcomes. Furthermore, there are clear studies linking prolonged surgical time to increase in infection rates, making robotic surgery a risky business for the patient.  Recent publication by Tompkins et Al., studied nearly 5000 patients randomized to two groups and saw no difference in revision rates at 10 years.  So where does computer navigated technology help?  

- Surgeons who perform less than 50 joint surgeries per year have been shown to have better outcomes with computer navigation.  The benefit of RTKA and RTHA, decreases with higher volume fellowship trained surgeons.  

- Difficult cases with significant destruction of bone from prior surgeries or fractures may benefit from a computer and CT scan/MRI bases planning.  

- Partial knee replacements may benefit from computer navigation is some cases where manual alignment is difficult.  This is where I use the robot the most. 

- Hips performed through the posterior approach, where dislocations and cup mispositioning is far more common.  

When it comes to hips, I use low radiation live x-rays to confirm component positioning and leg lengths during a direct anterior approach (DAA).  With fluoroscopic DAA, implant position and leg lengths are so close to my pre-operative planning that the additional cost and surgical time spent on computer navigation has not been useful in my practice.

See the link to the above mentioned publication. 

https://pubmed.ncbi.nlm.nih.gov/34808279/

Pavel Muradov M.D.

 

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