This is a interesting question to answer as both traditional and robotic hip replacements are excellent operations at treating arthritis and restoring quality of life. Traditional joint replacements are more established and therefore have a greater body of evidence behind them. Robotic joint replacements, such as the Stryker MAKO system that I use are well established with the first operation being performed in 2006, however this is still a much younger technique than traditional surgery. Not all robotic systems are the same, and not all surgeons have the same experience and confidence in using a robotic system therefore these thoughts may not apply to all surgeons and all robotic systems.
▲ Before and after a robotic hip replacement in a patient with severe arthritis, resulting in a shorter leg. The accurate CT planning identified large cysts in the socket that were filled with bone graft, and additional screws were used to provide increased stability. The robot allowed accurate measurement of leg length, which was corrected to the leg length before the arthritis damage. This patient was walking within hours of surgery, and left hospital within 24 hours of surgery.
What is Better
First we need to establish what ‘better’ means. In the broadest sense the goals of a hip replacement isto treat arthritic pain and restore quality of life with a long lasting implant. This means that ‘better’ will be different of different patients. A elderly patient who walks very short distances will measure success differently from a younger patient involved in more strenuous activities and sports.
We also need to note that robotic assisted surgery is one factor of many that contributes to the success of an operation. Other factors include surgeon experience and operative philosophy, patient selection and motivation, anaesthetic, post operative rehabilitation, the list goes on.
Treatment of pain
Treatment of arthritis pain is generally reliably achieved with both techniques. as the arthritic cartilage is removed with both techniques. Robotic surgery may have potential benefits in improving some post operative pain, for example when a robotic is used to align a joint replacement closer to a patients anatomy this can result on less stress on the ligaments and soft tissues which may imropove satisfaction levels.
Quality of life
Restoration of quality of life varies by a huge degree patient by patient, this could mean getting around ones house without pain, to playing golf, cycling and hiking mountains. Large meta-analysis (a type of research that combines multiple smaller studies) has shown MAKO robotic joint replacements result in better patient functional outcomes, and comparable to manual techniques in other metrics. It is important to note that most research comparing robotic and manual joint replacement compares a wide range of patients, and a wide range of surgeons and surgical techniques. It may be that Robotic Joint Replacement offers greater advantages in higher volume robotic surgeons and specific patient groups such as complex joint alignment, or higher function patients.
Longevity of a robotic hip replacement
Long lasting joint replacement. Modern hip replacements have excellent data on the national joint registry spanning over a decade, typically unless there is an early problem a joint replacement will last many many years. One advantage of the the MAKO robotic system is increasing the accuracy of implant positioning, and reducing the risk of a poor position which may cause problems such as dislocation in total hip replacement, or need for revision.
Final thoughts
It is to early to say conclusively whether a robotic hip replacement is better than manual joint replacement for all patients and all surgeons. Due to the large number of variables in hip and knee replacement it may take some time to answer this question and which patients will benefit most. One advantage that is already very clear is the increased accuracy of robotic surgery. It may be surgeons with a higher volume make maximum use of robotic assistance. Mr Samir Ali Salih believes that robotic surgery is a valuable technique that fits with his established surgical approach of patient centred hip replacement. It allows him to plan operations more accurately, and implement this plan more accurately with a view to getting patients going earlier and faster with a more natural feeling joint replacement.
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Mr Samir Ali Salih
I am a consultant hip and knee surgeon specialising in joint replacements for arthritis using the Stryker MAKO robotic system
This article was written with human intelligence