Presenters debate use of robotics in knee surgery
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Key takeaways:
- Compared with surgeons, robotics has the potential to provide more surgical solutions.
- More prospective, randomized trials to compare robotic vs. conventional knee surgery are needed.
LAS VEGAS — At the Knee Society Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting, Thomas K. Fehring, MD, FAAOS, and Simon Young, MD, FRACS, debated the use of robotics in knee surgery.
Although the use of robotics may allow surgeons to adjust alignment parameters during knee surgery, Fehring said this can be achieved manually. He added that using robots as a training tool may leave residents and fellows unable to perform the procedures with conventional instruments.
“My concern is that we’re developing a generation of knee surgeons who are good at video games and manipulating robotic screens but lack the technical skills to manage complex primary revision problems and might be unable to get out of an intraoperative jam,” Fehring said.
More research needed
Fehring noted prospective, randomized studies comparing robotic vs. conventional knee surgery are lacking, with the available research showing no differences in outcomes and longer surgical time with robotics. Most prospective, randomized studies that include robotic surgery also involve authors with financial conflicts, according to Fehring.
“Before adopting robotic surgery, ask yourself three questions: Who decided on the need for robotic knee surgery? Was it physicians or was it industry? And has the enthusiasm for robotics also outpaced the science? Most major companies now have a robotic option marketed without supporting outcome data,” Fehring said.
However, Young noted the potential of robotics has “nothing to do with the accuracy of the cuts” but with advanced navigation.
“To me, the potential of robotics is to be able to control what we’re doing in the operating room, to standardize it and learn exactly how to do it consistently,” Young said.
He added most robotic navigation systems allow surgeons to simultaneously review balancing and component positioning.
“Whereas previously you would plan your component position, make the bone cuts and then balance, now you can assist the balance by positioning components virtually before you make any cuts and perhaps make adjustments to their position to make sure you’re harmonizing the situation between component position and balancing,” Young said.
Prevent technical mistakes
Robotics may provide more surgical solutions, as well as potentially provide an optimal solution for a specific knee component in a way that a surgeon cannot, according to Young. However, he noted surgeons are still learning what the targets and tolerances are, and the use of navigation may help measure how components are being placed.
Although robotics may yield no differences in patient-reported outcomes when compared with conventional knee surgery, Young said research has shown robotics has the potential to prevent technical mistakes that can lead to reoperation or poor revision.
“I think patient selection and managing expectation is key to a good outcome. And the surgical skill of counseling your patients as to what the management options are for knee osteoarthritis and then helping them choose when the right time is to proceed with knee arthroplasty is a surgical skill that a robot is never going to be able to replace,” Young said.
References:
- Fehring TK. Robotics provide no patient benefit at this time. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
- Young SW. Robotics is the new gold standard. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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Fehring TK. Robotics provide no patient benefit at this time. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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