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Robotics in orthopaedic surgery: why, what and how?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Robotics applied to orthopedics has become an interesting topic both from the surgical point of view and the engineering one. The main goal of those systems is the enhancement of joint arthroplasty surgery, providing the robotic support to precisely and accurately prepare the bone, restore the limb alignment and the physiological kinematics of the joint. Various robotic systems are currently available on the market, each addressing specific kind of surgeries and characterized by a series of specific features that may involve different requirements and/or modus operandi.

Material and methods

An overview of these devices was performed, addressing the different categories in which robots are subdivided in terms of: operations performed, requirements and level of interaction of the surgeon. The main models currently available on the market were addressed and relative studies in the literature were reported and compared, to highlight the benefits and drawbacks of the different technologies.

Results

The different robotic systems were subdivided in: open/closed platform, image-based/imageless and active/passive/semi-active. Regardless of the typology of robotic system, the main aim is to improve precision and accuracy of the operation. It is to be noted that, regardless of the typology of robotic system, the surgeon is still in charge of the planning and approval of the operation: only the precise and consistent execution of his directives is entrusted to the robot. The positive factors have however to be weighed against the fact that robotic systems involve an important initial investment and most of the times require the surgeons and the staff to learn how to operate them (with a learning curve differing from system to system).

Conclusions

Each surgeon, when considering if and which robotic system to adopt, has to properly evaluate the different benefits and drawbacks involved to find the surgical robot that fits his needs the best.

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References

  1. Goldsmith MF (1992) For better hip replacement results, surgeon’s best friend may be a robot. JAMA 267(5):613. https://doi.org/10.1001/jama.1992.03480050011003

    Article  CAS  PubMed  Google Scholar 

  2. https://app.dimensions.ai/analytics/publication/overview/timeline?search_mode=content&search_text=robotics%20orthopedic&search_type=kws&search_field=full_search. Accessed July 2021

  3. Banerjee S, Cherian JJ, Elmallah RK, Pierce TP, Jauregui JJ, Mont MA (2016) Robot-assisted total hip arthroplasty. Expert Rev Med Devices 13(1):47–56. https://doi.org/10.1586/17434440.2016.1124018

    Article  CAS  PubMed  Google Scholar 

  4. Banerjee S, Cherian JJ, Elmallah RK, Jauregui JJ, Pierce TP, Mont MA (2015) Robotic-assisted knee arthroplasty. Expert Rev Med Devices 12(6):727–735. https://doi.org/10.1586/17434440.2015.1086264

    Article  CAS  PubMed  Google Scholar 

  5. National Joint Registry (2015) National Joint Registry 12th Annual Report: National Joint Registry for England, Wales, Northern Ireland and the Isle of Man Surgical data to 31 December 2014 [Online]. Available: https://www.hqip.org.uk/wp-content/uploads/2018/11/NJR-15th-Annual-Report-2018.pdf.

  6. Graves S, Davidson D, de Steiger R, Tomkins A (2012) Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide:AOA; 2012. vol. 2012http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp, [Online]. Available: https://aoanjrr.sahmri.com/documents/10180/689619/Hip%2C+Knee+%26+Shoulder+Arthroplasty+New/6a07a3b8-8767-06cf-9069-d165dc9baca7

  7. Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg 93(17):1588–1596. https://doi.org/10.2106/JBJS.J.00772

    Article  PubMed  Google Scholar 

  8. Jacofsky DJ, Allen M (2016) Robotics in arthroplasty: a comprehensive review. J Arthroplasty 31(10):2353–2363. https://doi.org/10.1016/j.arth.2016.05.026

    Article  PubMed  Google Scholar 

  9. Subramanian P, Wainwright TW, Bahadori S, Middleton RG (2019) A review of the evolution of robotic-assisted total hip arthroplasty. Hip Int 29(3):232–238. https://doi.org/10.1177/1120700019828286

    Article  PubMed  Google Scholar 

  10. Bautista M, Manrique J, Hozack WJ (2019) Robotics in total knee arthroplasty. J Knee Surg 32(07):600–606. https://doi.org/10.1055/s-0039-1681053

    Article  PubMed  Google Scholar 

  11. Sousa PL, Sculco PK, Mayman DJ, Jerabek SA, Ast MP, Chalmers BP (2020) Robots in the operating room during hip and knee arthroplasty. Curr Rev Musculoskelet Med 13(3):309–317. https://doi.org/10.1007/s12178-020-09625-z

    Article  PubMed  PubMed Central  Google Scholar 

  12. Smith-Bindman R (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169(22):2078. https://doi.org/10.1001/archinternmed.2009.427

    Article  PubMed  PubMed Central  Google Scholar 

  13. Netravali NA, Shen F, Park Y, Bargar WL (2013) A perspective on robotic assistance for knee arthroplasty. Adv Orthop 2013:1–9. https://doi.org/10.1155/2013/970703

    Article  Google Scholar 

  14. DiGioia A, Jaramaz B, Picard F, Nolte L-P (2004) Computer and robotic assisted hip and knee surgery. Oxford Univeristy Press, New York

    Google Scholar 

  15. Bargar WL, Bauer A, Börner M (1998) Primary and revision total hip replacement using the robodoc system. Clin Orthop Relat Res 354:82–91. https://doi.org/10.1097/00003086-199809000-00011

    Article  Google Scholar 

  16. Bargar WL (2007) Robots in orthopaedic surgery: past, present, and future. Clin Orthop Relate Res 463: 31–36. Available: http://www.ncbi.nlm.nih.gov/pubmed/17960673

  17. Chun YS, il K, Kim Y, Cho J, Kim YH, Yoo MC, Rhyu KH (2011) Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplasty 26(4):621–625. https://doi.org/10.1016/j.arth.2010.05.017

    Article  PubMed  Google Scholar 

  18. Jakopec M, Harris SJ, Rodriguez y Baena F, Gomes P, Cobb J, Davies BL (2001) The first clinical application of a hands-on robotic knee surgery system. Computer Aided Surg 6(6):329–339. https://doi.org/10.1002/igs.10023

    Article  CAS  Google Scholar 

  19. Park SE, Lee CT (2007) Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty 22(7):1054–1059. https://doi.org/10.1016/j.arth.2007.05.036

    Article  PubMed  Google Scholar 

  20. Song E-K, Seon J-K, Yim J-H, Netravali NA, Bargar WL (2013) Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 471(1):118–126. https://doi.org/10.1007/s11999-012-2407-3

    Article  PubMed  Google Scholar 

  21. Kazanzides P (2007) Robots for orthopaedic joint reconstruction. In: Faust R (ed) Robotics in surgery: history, current and future applications. Nova Science Publishers Inc, 415 Oser Avenue, Suite N, Hauppauge, New York, 11788 USA

    Google Scholar 

  22. Wu L, Hahne HJ, Hassenpflug J (2004) The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty. J Zhejiang Univ Science A 5(10):1270–1278. https://doi.org/10.1631/jzus.2004.1270

    Article  Google Scholar 

  23. Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116. https://doi.org/10.1097/BLO.0b013e318126c0c0

    Article  PubMed  Google Scholar 

  24. Siebert W, Mai S, Kober R, Heeckt PF (2002) Technique and first clinical results of robot-assisted total knee replacement. Knee 9(3):173–180. https://doi.org/10.1016/S0968-0160(02)00015-7

    Article  PubMed  Google Scholar 

  25. Siebel T, Käfer W (2005) Klinisches Outcome nach Roboter-assistierter versus konventionell implantierter Hüftendoprothetik: Prospektive, kontrollierte Untersuchung von 71 Patienten. Z Orthop Ihre Grenzgeb 143(04):391–398. https://doi.org/10.1055/s-2005-836776

    Article  CAS  PubMed  Google Scholar 

  26. Cobb J et al (2006) Hands-on robotic unicompartmental knee replacement. J Bone Joint Surg 88-B(2):188–197. https://doi.org/10.1302/0301-620X.88B2.17220

    Article  Google Scholar 

  27. Parratte S, Price AJ, Jeys LM, Jackson WF, Clarke HD (2019) Accuracy of a new robotically assisted technique for total knee arthroplasty: a cadaveric study. J Arthroplasty 34(11):2799–2803. https://doi.org/10.1016/j.arth.2019.06.040

    Article  PubMed  Google Scholar 

  28. Lang JE et al (2011) Robotic systems in orthopaedic surgery. J Bone Joint Surg 93-B(10):1296–1299. https://doi.org/10.1302/0301-620X.93B10.27418

    Article  Google Scholar 

  29. Hassebrock JD et al (2020) Minimally invasive robotic-assisted patellofemoral arthroplasty. Arthrosc Tech 9(4):e425–e433. https://doi.org/10.1016/j.eats.2019.11.013

    Article  PubMed  PubMed Central  Google Scholar 

  30. Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S (2019) Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27(4):1232–1240. https://doi.org/10.1007/s00167-018-5081-5

    Article  PubMed  Google Scholar 

  31. Herry Y, Batailler C, Lording T, Servien E, Neyret P, Lustig S (2017) Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique. Int Orthop 41(11):2265–2271. https://doi.org/10.1007/s00264-017-3633-9

    Article  PubMed  Google Scholar 

  32. Jaramaz B, Nikou C, Casper M, Grosse S, Mitra R (2018) Accuracy validation of semi-active robotic application for patellofemoral arthroplasty. Orthop Proceed 98-B

  33. Liow MHL, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 29(12):2373–2377. https://doi.org/10.1016/j.arth.2013.12.010

    Article  PubMed  Google Scholar 

  34. Conditt MA, Roche MW (2009) Minimally invasive robotic-arm-guided unicompartmental knee arthroplasty. J Bone Joint Surg 91(Supplement_1):63–68. https://doi.org/10.2106/JBJS.H.01372

    Article  PubMed  Google Scholar 

  35. Plate JF et al (2013) Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop 2013:1–6. https://doi.org/10.1155/2013/837167

    Article  Google Scholar 

  36. Yildirim G, Fernandez-Madrid I, Schwarzkopf R, Walker P, Karia R (2013) Comparison of robot surgery modular and total knee arthroplasty kinematics. J Knee Surg 27(02):157–164. https://doi.org/10.1055/s-0033-1360654

    Article  PubMed  Google Scholar 

  37. Bukowski BR, Anderson P, Khlopas A, Chughtai M, Mont MA, Illgen RL (2016) Improved functional outcomes with robotic compared with manual total hip arthroplasty. Surg Technol Int 29: 303–308. Available: http://www.ncbi.nlm.nih.gov/pubmed/27728953

  38. Illgen RL et al (2017) Robotic-assisted total hip arthroplasty: outcomes at minimum two-year follow-up. Surg Technol Int 30: 365–372. Available: http://www.ncbi.nlm.nih.gov/pubmed/28537647

  39. Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS (2019) Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Reviews 4(10):611–617. https://doi.org/10.1302/2058-5241.4.190022

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS (2019) Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 27(4):1132–1141. https://doi.org/10.1007/s00167-018-5138-5

    Article  PubMed  Google Scholar 

  41. Vermue H et al (2020) Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06341-6

    Article  PubMed  Google Scholar 

  42. Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C (2020) Robotic arm-assisted knee surgery: an economic analysis. Am J Manage Care 26(7):E205–E210. https://doi.org/10.37765/ajmc.2020.43763

    Article  Google Scholar 

  43. Hamilton WG, Ammeen D, Engh CA, Engh GA (2010) Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplasty 25(5):735–740. https://doi.org/10.1016/j.arth.2009.05.011

    Article  PubMed  Google Scholar 

  44. Lonner JH (2009) Indications for unicompartmental knee arthroplasty and rationale for robotic arm-assisted technology Am J Orthop 38(2 Suppl): 3–6. Available: http://www.ncbi.nlm.nih.gov/pubmed/19340375

  45. Coon TM (2009) Integrating robotic technology into the operating room. Am J Orthop 38(2 Suppl): 7–9. Available: http://www.ncbi.nlm.nih.gov/pubmed/19340376

  46. Nherera LM, Verma S, Trueman P, Jennings S (2020) Early economic evaluation demonstrates that noncomputerized tomography robotic-assisted surgery is cost-effective in patients undergoing unicompartmental knee arthroplasty at high-volume orthopaedic centres. Adv Orthop 2020:1–8. https://doi.org/10.1155/2020/3460675

    Article  Google Scholar 

  47. Moschetti WE, Konopka JF, Rubash HE, Genuario JW (2016) Can robot-assisted unicompartmental knee arthroplasty be cost-effective? A markov decision analysis. J Arthroplasty 31(4):759–765. https://doi.org/10.1016/j.arth.2015.10.018

    Article  PubMed  Google Scholar 

  48. DeFrance MJ, Yayac MF, Courtney PM, Squire MW (2020) The impact of author financial conflicts on robotic-assisted joint arthroplasty research. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.10.033

    Article  PubMed  Google Scholar 

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The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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  1. BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Bruxelles, Belgium

    Bernardo Innocenti & Edoardo Bori

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Innocenti, B., Bori, E. Robotics in orthopaedic surgery: why, what and how?. Arch Orthop Trauma Surg 141, 2035–2042 (2021). https://doi.org/10.1007/s00402-021-04046-0

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