What about Robots? 🤖

LIFETIME HIP & KNEE

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#120: Robotic surgery

Try Google-ing ‘Robotic surgery’, you get..

=> Links to hospitals telling you 'we have a robot'!

=> NOT many links to the evidence about better outcomes.

AND many of the papers don't report on what really matters. BUT there was one paper last year that did.

First, a quick recap..

What is Robotic surgery?

Robotic surgery conjures up a picture of a humanoid robot..

Scalpel in one 'hand', patient draped, sterile field, not a human in sight..

That’s not where we’re at,..

Robot surgery is better described as Robot-assisted surgery.

There is very clearly a human in the room.. at the operating table!

And better still described as mechanical arm- assisted surgery

It is still very much just a tool for the human surgeon.. phew!

The ‘Robot’ is a fairly simple mechanical arm that swings in to help align the guides we use to cut the bone. The saw + saw blade is still very much held + controlled by a human hand.

The 'robot' mechanical arm is most often used for knee replacement..

BUT it was a hip replacement paper that stood out last year as a first randomised controlled trial (RCT) looking at the 'robots'.

Always look for the RCT.

So, what did the RCT show..?

=> No Difference

In terms of what really matters to people + patients..

There was no difference in pain and function at 1 year. ..Robot or NO Robot

Yes, mechanical assistance put the implants closer to the planned position- it limited the outliers- but there was no overall clinical effect.

What Really Matters..

This paper is a great example of what to look for:

Quality evidence: the Randomised Controlled Trial (RCT) or Metanaylsis of multiple RCTs
What really matter: the Patient Reported Outcome Measures (PROMs) that tell you about pain + function.

A lot of published research points to better looking x-ray films..

Yes, John or Jane want to know that their x-ray films look good..
BUT not at the expense of a painful hip or knee replacement.

X-ray films are easy to measure. The 'robot' mechanical arm is a better measurement tool. And if you use a better measurement tool.. it's not surprising that the x-ray film looks better, more often.

Measuring outcomes that really matter to people, however, is hard. It's relies on people filling out questionnaires.

Measuring pain + function is therefore hard. So, there are fewer research papers out there telling us about what really matters.

This paper tells us clearly that, at the moment- the robots do NOT further improve pain + function.

There may be future potential. BUT, for now, there are more important things to focus on 👏👏

Next week

Let's look at a few papers published about partial or unicompartmental knee replacement. UKR research coming up..

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Duchy Hospital
Truro
TR1 3UP
United Kingdom