Robotic Technology in Orthopaedic Surgery

Abstract

* Robotic technology used in orthopaedics can be classified on the basis of direct and indirect action and according to the mechanism of cutting, including autonomous, haptic, and boundary control.* Robotics have been used in multiple orthopaedic subspecialties including spine, total joint arthroplasty, trauma, shoulder, and foot and ankle.* Advantages of using robotic technology in orthopaedics include the possibility of improving implant placement (e.g., reducing outliers), accessing certain anatomic areas, reducing complications, decreasing fluoroscopy use, and performing remote surgery.* Disadvantages of using robotics in orthopaedics include increased costs, the need for updated software, the surgeon learning curve and increased operative time, imaging for preoperative templating, potential incorrect placement of implants with poor input of data from the surgeon, and possibly no difference in long-term outcomes.

Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases

“…Robot-assisted spinal surgery has been a popular and reliable surgical technique for recent years. 1,7,12,[17][18][19][20][21][22][23][24] Roser et al 24 reported that the accuracy of pedicle screw placement in SpineAssist robot-assisted spinal surgery was 99%. Lonjon et al 25 claimed that the accuracy of pedicle screw placement using the ROSA robot system was 97.3%, compared with 92% using freehand method.…”

“…It increases the accuracy and process repeatability of implant placement and has a great potential in making a better and safer clinical outcome for orthopedic operation. 1 With a booming of the technology revolution, operational techniques and implants in spinal surgery continue to develop through these years. 2 In spinal fusion surgery, the accuracy of pedicle screw fixation can be increased significantly with the application of computer-assisted robotic system.…”

Surgeons and robots

“…Computer-assisted navigation systems use referencing methods to virtually reconstruct the area of interest and display it on a screen enabling the surgeon to receive real-time feedback intraoperatively [2]. Robotics use computer-guided mechanical arms that enable surgeons to perform surgery remotely, and allow for more accurate and reproducible placement of surgical instruments and implants [3]. Based on the method used for information referencing, navigation systems can be computer tomography (CT)-based, fluoroscopy-based and imageless.…”

“…Robots can act directly, when they cut the bone to the final desired shape; or indirectly, when they machine features in the bone to allow placement of cutting jigs. Furthermore, robotic bone cutting can be autonomous, when the robot cuts bone with no controlling human hand; haptic, when human interaction is required to move the robot to cut but the robot's movement is constrained by a border; and boundary, when human interaction is required to move the robot but cutting is deactivated or prevented by some means if it travels beyond a boundary even though it is free to move anywhere in space [3].…”

“…With the use of semi-active robotic systems in total hip arthroplasty, the surgeon may control the robotic arm to ream the acetabulum to a specified depth and size, without the need for sequential reaming. Imaging software can also control for limb length equality [3][4][5][6][7][8][9][10][11].…”