What are the current robotic systems used in hip and knee joint replacement surgeries in orthopaedics, and what are their characteristics and differences?

Current Robotic Systems in Hip and Knee Joint Replacement

Multiple robotic platforms are currently available for total knee arthroplasty (TKA), but the American Academy of Orthopaedic Surgeons provides strong evidence that robotic systems increase operative time without improving long-term clinical outcomes or survivorship compared to conventional techniques, and therefore should not be routinely used. 1

Major Robotic Platforms for Knee Arthroplasty

ROBODOC (T-SOLUTION ONE)

• Autonomous, active robotic system that was the first introduced for orthopedic surgery in 1992 2, 3
• Originally designed for total hip replacement, later adapted for TKA 3
• Long-term data (>10 years) shows no improved clinical outcomes compared to conventional technique 2
• Has largely fallen out of favor due to lack of demonstrated clinical benefit 3
• Requires pre-operative CT imaging (image-based system) 4

MAKO System

• Semi-active, haptic-guided robotic system that uses haptic boundaries to prevent surgical error 4, 5
• Provides an effector end that actively prepares bone while the surgeon maintains control 5
• Requires pre-operative CT imaging for surgical planning (image-based system) 4
• Published complication and revision rates show no clear differences compared to conventional TKA 2
• Short-term clinical outcomes available, but long-term data limited 2
• Currently expanding into shoulder arthroplasty applications 5

NAVIO (now CORI)

• Semi-active, imageless robotic platform that does not require pre-operative CT scanning 2, 4
• Uses intraoperative mapping and registration for surgical planning 4
• Demonstrates improved surgical precision compared to conventional technique 2
• Limited published data on clinical outcomes and revision rates 2
• Similar learning curve based on operative time as other platforms 2

ROSA System

• Collaborative, passive robotic system that positions cutting guides and reamers through combined surgeon-robot effort 5
• Once desired position achieved, robot enters static mode and surgeon performs osteotomy or reaming 5
• Can be used as imageless system 4
• Available for both knee and shoulder arthroplasty 5
• Limited published outcome data specific to this platform 2

OMNIBot Platform

• Imageless, passive robotic system available since 2007 with over 30,000 TKAs performed 6
• Small physical footprint, relatively inexpensive, and time-efficient compared to other platforms 6
• Demonstrates 99.26% survivorship at 3 years in published data, and 99.48% at 6 years in clinical practice 6
• High level of precision in surgical planning with modestly improved accuracy compared to conventional and navigation technology 6
• Can be used with BalanceBot soft-tissue tensioning device for tibio-femoral coronal balancing 6
• Reliable tool for delivering different alignment philosophies 6

Key Differences Between Systems

Classification by Autonomy Level

• Autonomous (active): ROBODOC - robot performs bone preparation independently 3
• Semi-active (haptic): MAKO, NAVIO - robot provides haptic boundaries while surgeon controls cutting 4, 5
• Passive (collaborative): ROSA, OMNIBot - robot positions guides/tools, surgeon performs cutting 5, 6

Classification by Imaging Requirements

• Image-based systems: ROBODOC, MAKO - require pre-operative CT scanning for surgical planning 4
• Imageless systems: NAVIO, ROSA, OMNIBot - use intraoperative registration and mapping 4, 6

Common Characteristics Across All Platforms

• All systems demonstrate improved radiological precision and surgical accuracy compared to conventional technique 2
• All platforms show similar learning curves based on operative time 2
• Most systems require longer operative time compared to conventional TKA 2
• Surgeon remains in charge of planning and approval; robot executes directives precisely 4
• Require significant initial investment and staff training 4
• Need larger operating room space 5

Critical Limitations

Evidence Quality Issues

• Each robotic system has diverse evidence in quantity and quality, and must be assessed for its own value 2
• The generic term "robotic" should not be used for general conclusions, as systems differ substantially 2
• Most platforms only present short-term clinical outcomes 2
• Gap balance assessment performed differently between systems, leading to heterogeneous outcomes 2

Clinical Recommendation

The American Academy of Orthopaedic Surgeons provides strong evidence against routine use of robotic assistance, as these systems provide no clinical benefit in pain, function, or alignment over conventional techniques, while consistently increasing operative time. 1, 7 This recommendation applies despite improved radiological precision, as this has not translated into improved patient-reported outcomes, reduced complications, or enhanced survivorship 1, 2.

Robotic Systems for Hip Arthroplasty

• ROBODOC was originally designed for total hip replacement in 1992 3
• Robotic assistance has demonstrated value in hip arthroplasty applications 5
• Limited current literature specifically addressing robotic hip systems compared to knee platforms 2, 3