Robotics in total joint surgery has grown in 2022. By the next decade, surgeons predict continued growth, along with the further integration of artificial intelligence and augmented reality.
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Editor's note: Responses were lightly edited for clarity.
Question: Looking to 2030 and beyond, how will orthopedic surgeons be able to use robots for total joints?
James Abbott, MD. Best Surgery & Therapies (Cincinnati): The robotic platforms will only get faster at registration of the joint position and recognizing deformity, determining alignment and intraoperative planning. The planning will move faster with AI algorithms that can plan and balance the knee instantaneously. Ideally, these AI algorithms will be based on outcomes data on patients that have had robotic surgery and developed to optimize the kinematics specific to the knee design utilized. The next difference will be on how we remove the bone. Currently we use saws and burrs, but that could be replaced with computer-controlled micro machines to remove the bone and prep for implants accurately and cause less pulling and tugging on the soft tissues. Still, current implant designs require enough exposure to accurately place the implant once the bone prep is complete. It would be great if the systems eventually evolve to an open-source platform that can be loaded with software specific to the implant, but given our current fragmentation of the industry, that will be decades away.
Anthony Melillo, MD. Bay Oaks Orthopaedics & Sports Medicine (Houston): I have used the Stryker Mako Robot to perform my partial and total knee replacements and total hip replacements (including revisions) for over seven years. I was hesitant at first since it was a new concept. But I can now say that I will never do another joint replacement without this technology.
I have now corrected wildly deformed knees and hips [and] arthritic joints successfully and confidently using this platform. The computer-based program and pre-op CT scan allows me to realistically correct the deformities in advance of my surgery. I can see the obstacles and plan for the correction of them pre-op and have corrective measures ready at the time of surgery.
Bottom line, robotics in total joints, especially by 2030, will be the standard of care. Think about having the ability to place an acetabular cup in the exact place that maximizes hip movements in an individual taking into account lumbar motion, hip motion, etc.
Vivek Mohan, MD. OC Irvine (Calif.) Medical Center and OC Anaheim (Calif.) Medical Center: The robotic footprint will grow and continue to grow rapidly. However, the economy of scale and the deployment of vast resources to get these robots in operating rooms around the world will eventually halt. At that point alternative technologies such as augmented reality and ocular base technology will take over.