Robots, or robotic elements, are already used for many types of surgeries, including orthopedic procedures such as hip and knee replacements. But what future do robots have in the field of orthopedics?
Will robotics help advance the field, providing better services to patients who have other orthopedic problems such as clubfoot or spinal deformities? Or are they an expensive investment that can’t live up to the hype?
Erica and Alex Crisses know what a difference these special surgeries and technological advances can make; when Erica was 20 weeks pregnant, they found out their daughter had a unilateral clubfoot. Through the work of HSS, their daughter’s clubfoot was corrected—and ever since, they have been on the HSS Pediatric Council, supporting advances so that others may be helped, too.
Robotic and computer assistance are already being used in orthopedic surgery, but only in a few procedures. “Up until now, a lot of the advanced techniques using computer assistance have been facilitating, which means they made the surgery more precise,” says Andrew Pearle, MD, an orthopedic surgeon at Hospital for Special Surgery in New York City. “Now, we are starting to see more programs that are enabling, which means making it possible to do surgeries that surgeons couldn’t do before.”
Computer-assistance technology really caught on in the field when minimally invasive joint replacements were introduced. Imaging and guidance through the smaller incisions allowed more precise implant placement and gave surgeons a way to plan surgery in advance, making operations shorter and smoother.
In recent years, robotic systems have assisted surgeons in the actual cutting and grinding of bone surfaces, which allows for more accurate planning and better implant fit. But the long-term results of this may not be seen for quite some time.
“A well-positioned implant may not mean the patient feels better in the first five years, but it could mean that the implant is more durable over the second five years,” says Dr. Pearle.
That said, there are significant barriers to adoption of robotic technology in orthopedic surgery, the most important of which is the lack of strong, evidence-based studies showing that robots produce better outcomes. “We have to show using the robot is better than conventional techniques, and it’s got a long way to go,” says Dr. Pearle.
Surgeons need to take a great deal of time to learn to use new robots and gain expertise, and many are reluctant to do so until they are sure those robots will produce better results.
However, for every orthopedic surgeon taking a “wait and see” approach, there is at least one who is excited about current and emerging robotic technology in orthopedic surgery.
Bert Mandelbaum, MD, of Santa Monica Orthopedic and Sports Medicine Group, says, “As a diversified clinical and academic orthopedic surgeon, I am comprehensively dependent on computerizations and apps. Yes, robots will, and now have, a definite role in the planning and execution of arthroplasty procedures.”
Other technology such as 3-D printers to replace standard orthopedic implants with customized devices could grow or disrupt the orthopedic robotics market, depending on whether surgeons decide to use 3-D modeling to enhance emerging robotic technology or replace it. Treatments like biologics, regenerative medicine that could build new cartilage, and sensors that detect the presence of biofilm that leads to infection could prove to be great enhancements to joint implant technology, whether robotically enhanced or not.
Right now, there is no way to know for sure whether orthopedic robotics will live up to the hype, but if the clinical evidence sides with the hype, you can expect to see a greatly expanded presence of robots in orthopedic surgery suites in the near future.