The Lancet: Robots place knee implants more precisely, but do not speed up recovery

A robotic system helps surgeons position knee implants with significantly greater precision, but this does not provide patients with noticeable benefits during the first year after surgery compared with traditional surgery. This is the conclusion reached by the authors of the world’s largest randomized trial of robotic-assisted knee replacement. The study was published in the scientific journal The Lancet.

The RACER-Knee trial included 339 patients from 10 hospitals in the UK, with surgeries performed by 33 surgeons. Researchers compared conventional total knee replacement with procedures performed using the Stryker Mako robotic system.

Robotic systems are increasingly being used for knee replacement surgery. In the UK, they account for about 6% of knee replacement procedures, compared with 16% in the US and 42% in Australia. Their purpose is to help surgeons position implants with maximum precision and tailor the procedure to each patient’s individual anatomy.

However, one year after surgery, researchers found no significant difference between the two groups. Patients in both groups walked equally well, reported comparable levels of pain and had similar perceptions of their artificial joints in everyday life.

The main measure of effectiveness was the so-called Forgotten Joint Score, a scale that assesses how much a person notices the presence of an artificial joint during normal daily activities. After 12 months, the results were virtually identical in both groups.

There were also no significant differences in other measures, including pain during the first three months and at one year after surgery, pain while in hospital, or the need for revision surgery.

At the same time, robotic surgery was indeed more precise. The system allows surgeons to adjust the angle and depth of bone cuts with a high degree of accuracy, potentially enabling them to position the implant according to the individual patient’s anatomy.

The safety of robotic procedures was also comparable to that of conventional surgery, with researchers finding no increased risk of serious complications.

The drawbacks were higher costs and longer operating times. On average, robotic knee replacement took 10.5 minutes longer and cost approximately $1,300 more.

However, the researchers do not view the findings as a verdict against robotic surgery. They suggest that the high precision offered by robotic systems could prove particularly valuable if doctors become better at determining the optimal implant position for each individual patient.

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