Chad Mitchell, MD, an orthopedic surgeon at Orthopaedic Associates in Panama City, Fla., connected with Becker's to discuss how knee and hip replacements could evolve over the next five years.
Note: This response has been lightly edited for length and clarity.
Dr. Chad Mitchell: Robotic-assisted joint replacement has made some great strides since robotics were introduced to orthopedic surgery in the 1990s. A tour of the 2023 AAOS Annual Meeting exposition hall showed me that robotics in joint replacement has evolved into a competition among independent surgical robotic systems looking for an implant and implant companies incorporating robotics into their surgical techniques. The most popular FDA-approved systems include Mako 2.0 from Stryker, Cori from Smith+Nephew, and Rosa from Zimmer Biomet. These systems incorporate computer navigation for templating and robotic assistance to make the precision bone cuts for brand specific implants.
While not FDA approved, the TMax from Think Surgical is touted as an autonomous robot with surgeon controls for safety. That's right, an autonomous robot that could one day replace me, an orthopedic surgeon, and possibly replace the orthopedic sales representative, if it learns to open boxes! After studying these systems, it didn't take me very long to realize the large technological leap that will occur in the next five to 10 years in performing joint replacements.
Robotic-assisted surgery seems to have positively affected my knee replacement outcomes over the last two years, although long-term studies are needed to prove it. The more I use robotics, the more I realize how imperfect my previous saw cuts were. The robotics with the computer navigation has definitely made my total knee arthroplasty cuts more consistent and made balancing a knee more predictable. This seems to translate into early improved range of motion for patients and hopefully improved long-term outcomes.
With the large leap in computer speed and processing power, the robotic assistance seems much more real-time with no noticeable delays. At times, it seems like I am playing some type of video game. That begs the question of how will hip and knee replacements evolve over the next five or even 10 years given this large leap in technology?
While I certainly do not have prophetic powers to predict the future, it seems obvious to me where all of this is headed. Technologies like viewing bones under the skin with virtual reality glasses (augmented reality), 3D mapping of bones by CT scan or computer, and precision templating that takes into account the balancing of the soft tissues have the potential to improve a surgeon's ability to consistently perform these procedures with great accuracy and possibly great benefit to patients.
This could also lead to some creative thinking outside of the box. Could it be that new implant designs are possible given the improved precision from the technology? Will revision arthroplasty patients see a benefit from the navigation and robotic-assistance? Will this technology shorten the incisions for minimally invasive joint replacements? Will joint registry data influence the technology? Will artificial intelligence start playing a role? I answer with a profound yes to all of these questions. The potential benefits of computer navigation and robotic-assistance for patient care have me convinced that these technologies are benefiting patients now.
One problem that I see is that patient education on these emerging technologies is lagging behind. Most of my patients are not aware that this technology exists, and there is not an online platform dedicated to educating the public in these technologies.