Current Concepts in Robotics for the Treatment of Joint Disease

Adoption of a new technology in surgery today is subject to assessment by many stakeholders. These include surgeons, patients, hospitals, regulators, and payers. The fundamental tool for assessment is the determination of “value.” But value has different meanings for each of the stakeholders. The usual definition of value is “outcome divided by cost.” Although cost is usually measured in dollars, the measures for “outcome” are not clearly defined nor agreed upon. What follows is an attempt to define the value of robotic surgery in joint replacement surgery for each of the stakeholders. First, however, we need to understand that the primary value of robotics in joint replacement is the reduction of human error by improving accuracy and precision. This is the same value that has resulted in adoption of robotics in most manufacturing processes. A major part of quality control in manufacturing is optimizing accuracy and precision by reducing human error. Surgery, however, is a blend of intelligence, art, and skill. There are many human skills that are poorly performed by robots and vice versa. The appropriate use of robotics in joint replacement surgery is intended to improve the accuracy and precision of implant selection and placement as well as execution by bone preparation. The goal is not to replace the surgeon but to enhance the surgeon's performance. Robotics offers a tool that enables the surgeon to reproduce his/her best performance on a consistent basis.