Robotics in Orthopedic Surgery: 6 Points on the Present and Future

Becker's Orthopedic, Spine & Pain Management Review—June 13, 2011

Andrew D. Pearle, M.D., Orthopedic Surgeon at Hospital for Special Surgery, offers his perspective on the present and future of robotic technology.

Robotic and computer-assisted technology is now available for use during orthopedic and spine procedures. There are many concerns associated with the efficacy and efficiency of this technology, especially since it costs hospitals a great deal of money to acquire. Here, orthopedic and spine surgeon leaders discuss six points on where the technology is now and where it will likely head in the future.

1. What robotic and computer-assisted technology is capable of now. Currently, there are only a few orthopedic procedures, such as partial knee and hip replacements that have robotic or computer-assisted technology to help facilitate the surgeries. "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 seem more programs that are enabling, which means making it possible to do surgeries that surgeons couldn't do before."

2. Applying evidence-based research to robotic technology. Strong, evidence-based studies showing that robotic technology produces better outcomes are lacking, and many orthopedic surgeons are unsure of spending the extra time and money to train on the systems. "We have to show using the robot is better than conventional techniques, and it's got a long way to go," says Dr. Pearle. "Up until now, robotics has been promoted and expanded mainly because of marketing successes of the robotic companies."

Dr. Pearle is participating in research at Hospital for Special Surgery using the technology on cadavers, but the best studies using humans take several years to complete.

"A lot of computer surgery or robotics improves implant positioning, and the improved effects of implant positioning sometimes aren't seen for 10-20 years," he says. "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. It's pretty clear, at least with total knee replacement, that implant positioning may not be as important in the short term as fixation strategies, surgical techniques and patient selection."

3. Marketing the technology. "Marketing can only take you so far, and now we have to show that the technology is better," says Dr. Pearle. "These systems cost so much that hospitals tend to create a marketing effort when they buy one of these products. That is a bad thing because it limits the substantive research that needs to be done for robotics."

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