Robotic Surgery in Total Joint Replacement

By: William F. Sherman M.D., Victor J. Wu M.D.

In the past decade, the popularity of robot arm-assistance in total joint arthroplasty (TJA) has outpaced the reporting of long-term data.  This study aimed to understand the motivations for use and perceptions of the technology amongst total joint surgeons.

Methods: An online survey was distributed to membership of the American Academy Association of Hip and Knee Surgeons (AAHKS).  Questions asked for respondent's motivations for utilization the technology, perceptions regarding outcomes and training, and personal characteeristics that may have influenced responses.

Results: Increased precision was the primary reason for users (73.1%) to utilize robot arm-assistance in total joint procedures.  Non-users were just as likely to consider adopting the technology because of increase precision and marketing.  Non-clinical reasons such as marketing, administrative pressure, and peer pressure were primary motivators for 19.7% of users of the technology.  Respondents regardless of financial interest and use of the technology felt that robot arm-assistance increased operative time (76.5%) and was not more cost-effective than traditional methods (78.7%).  A majority of AAHKS members felt that 20-40 surgical cases were needed to become competent with the technique (54.1%).  A unique finding is that a larger proportion of orthopaedic surgeons considered themselves "innovators" or "early adopters" than expected for the general populaiton according to Roger's Diffusion of Innovations.

Conclusion: This study demonstrates that the decision to adopt robot arm-assistance in TJA is multifactorial and may have a significant contribution from non-clinical factors and inherent surgeon characteristics.  Continued evaluation of surgeon perceptions will be valuable as new evidence emerges regarding long-term outcomes.

William Sherman MD Board Certified Orthopedic Surgeon Fellowship Trained Knee/Hip Replacement Surgery

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