Our Study at HSS Finds Knee Replacement with Robotic Assistance Leads to Lower Complication Rate

These days you hear a lot about the use of robotics in joint replacement and other surgical procedures. Many orthopedic surgeons who perform robot-assisted surgery find that it improves the accuracy and predictability of a knee or hip replacement. 

Indeed, the use of computer-assisted navigation and robotic assistance for total knee replacement has grown tremendously over the past few years and shows no sign of slowing down. Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision.

A large study we undertook at Hospital for Special Surgery (HSS) found another major advantage of using a robot. Accessing and analyzing a huge national database with information on more than one million knee replacement patients, we found that surgery performed with robotic assistance led to a lower complication rate in the first three months following surgery. The research, which appeared in the October issue of Arthroplasty Today, also found that the nationwide use of a robotic system in knee replacement increased more than 2,000% from 2010 to 2018.  

The goal of our study was to take a closer look at technology-assisted knee replacement trends. We also set out to review the 90-day complication rate requiring readmission to the hospital after surgery. Although both computer-assisted navigation and robotic-assisted knee replacement have demonstrated increased precision with component positioning and alignment, it was unclear if this translated into improved patient outcomes. 



Using a national database, we compiled information on more than 1.3 million patients who underwent a primary, elective total knee replacement between 2010 and 2018. Patients were divided into three groups: those who had conventional surgery; individuals who had technology-assisted knee replacement with computer navigation; and patients who had robotic-assisted joint replacement surgery. 

We found that the use of robotic-assisted knee replacement grew considerably from 2010 to 2018, with an increase in utilization nationwide of more than 2,200%. The largest increase took place between 2016 and 2018.

The use of a robot also led to a lower complication rate. Robotic-assisted surgery had significantly lower odds of complications requiring readmission to the hospital within 90 days of surgery, with a rate of 1.57%, compared to conventional knee replacement, which had a complication rate of 2.55%. The data imply that for every 102 patients treated with robotic-assisted knee replacement, one readmission may be avoided.

Joint replacement, whether conventional or assisted with technology, is highly successful overall in relieving arthritis pain and improving quality of life. The advantage of the robotic system is that it allows us to customize the procedure for each patient. It enables optimal alignment and positioning of the knee implant, as well as optimal ligament balancing, important to the long-term success of the surgery.

Several robotic-assisted knee-replacement systems are on the market. I use the Mako system. Before surgery, a CT scan is taken of the patient’s knee. The scan is then uploaded into the Mako system software, where a 3D model of the joint is be created. The 3D model is used to plan and assist in performing the joint replacement.

In the operating room, the orthopedic surgeon controls a robotic arm that uses computer‐guided mapping software, similar to GPS, integrated into the surgical instruments to position the implant in the knee joint.  The digital tracking system constantly monitors and updates the patient’s anatomy and enables the surgeon to make real‐time adjustments to optimize implant placement, alignment, ligament balance and joint motion. This provides each patient with a personalized surgery tailored to his or her individual anatomy.

With more accurate alignment and positioning, many believe the implant should experience less wear and friction, and it could ultimately last longer. Time will tell, as future studies will be needed to determine if robotic-assisted surgery extends the longevity of a joint replacement. 


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