Robotics in orthopedics has emerged as a transformative technology, revolutionizing surgical precision and patient outcomes. As of 2020, over 5,500 da Vinci robotic systems (although not used specifically for orthopedic procedures) were installed in hospitals across the United States,¹ highlighting the growing adoption of robotic-assisted surgery.

The global surgical robotics market reached $8 billion in 2022 and is anticipated to double by 2027 (Table 1).^1,2 According to Technavio, the orthopedic surgical robotics market is expected to accelerate growth at about 27% CAGR through 2028.³ This growth is driven by the potential benefits of robotic-assisted orthopedic surgeries, including improved accuracy and precision in implant placement, potentially leading to better clinical outcomes, shorter recovery times, and fewer revisions.⁴

Today, orthopedic robotic systems are primarily used for partial or full knee replacements and total hip replacements, as well as spinal surgeries. The adoption of robotic surgery in orthopedics has seen a significant increase in recent years due to the anticipated benefits highlighted in the literature, but real-world experience also illustrates how beneficial these devices can be. 

Andrea Light, an orthopedic industry leader with over 20 years of experience working with implants, instruments, and robotics at DePuy Synthes and Smith+Nephew suggests other considerations. “Not only can robotic orthopedic systems improve accuracy and precision of bone cuts, they may also improve implant placement and minimize soft tissue disruption. Those with computational power use machine learning algorithms to refine robotic movements and surgeon’s techniques during surgery, adapting to real-time changes in tissue conditions for increased accuracy, all leading to a more precise and, hopefully, more successful surgery. Some systems can make surgeries more repeatable and add the ability to learn from techniques that lead to better surgical outcomes.”

Additionally, she highlights the use of machine learning capabilities, which are starting to be seen to improve outcomes through analysis of patient data. This enables improved prediction of potential complications or recovery timelines, allowing for better informed decision-making. 

While robotics are not always the best option for a particular procedure, hospital administrators are keen to employ this technology when it is available. We have heard, first hand, of patients who are seeking surgeons or hospitals utilizing robotics for orthopedic surgeries and are willing to go elsewhere if the robot is not available. An example of how marketing comes into play can be seen with the success of Stryker and its MAKO robot. Surgeons, hospitals, and patients now often refer to a knee replacement using a Stryker implant as a “MAKO Knee.” 

Given this demand and the high cost of remaining current in this space, hospital staff have many considerations when bringing a system in-house. Looking at the proven efficacy of the robotic system is key to ensure they are acquiring a useful and beneficial system. However, the simple logistics like size, overall footprint, and costs are significant barriers to system use. 

Size of the systems can be of great  importance not only for the main hospital, but also to ambulatory surgery centers (ASCs) as we witness a shift in site for orthopedic procedures. ASCs may not have the required space to house large robotic systems. Furthermore, smaller robotic systems that are portable and can be transported from one OR to another or from the hospital to the ASC can add an efficiency benefit as well.

Cost considerations are also taken into account, but the investment in robotic systems can vary greatly with capital equipment costs ranging from $300,000 to $1.5 million. In addition, the need for specialized disposables for each surgery are not to be forgotten and may affect reimbursement rates and profitability. 

A study evaluating the costs of a set of robotic and assistive technology for a total knee replacement (TKA) in 2022 detailed the costs of using different robotic options (Table 2).⁵ While this information was sourced from a small set of institutions over nine observed procedures conducted by three different surgeons compared to conventional jig-based TKA, the data suggested the cost of robotic surgery does need to be considered within the set of choices offered to patients.

Light suggests, “It’s arguable that the use of robotics in orthopedic surgery can make surgeons better surgeons. Surgeons must first get through the ‘learning curve’ period of using robots during surgery. This learning curve can add significant time and initial frustration during orthopedic procedures. However, once a surgeon becomes proficient at using a robot in orthopedic surgeries, such as a knee replacement, the surgeon’s precision and accuracy of bone cuts, implant sizing, and implant placement will likely improve, as may predictability of outcomes. The use of robotics allows the surgeon to much better tailor orthopedic surgery to individual patients’ anatomy, while mitigating possible risks and complications.”

The MedTech Strategies Perspective 

We all recognize robotics will be an ever-growing part of the surgical world. Companies are continuing to make improvements and launch new features to ensure a safer and more effective procedure, hopefully at a good price. It will be interesting to see what the vendors do to continue to offer updates and improvements and what data will ultimately show the clinician as well as the economic benefit for patients.

References

¹ tinyurl.com/odt250101
² tinyurl.com/odt250102
³ tinyurl.com/odt250103
⁴ tinyurl.com/odt250104
⁵ tinyurl.com/odt250105

MORE FROM THIS AUTHOR: The Growth of ASCs for Orthopedic Procedures

Ilsa Webeck has more than 30 years of work experience assessing commercial and market viability in the medtech space. After founding MedTech Strategies in 2014, she has worked with a wide range of organizations focused on assessing commercial fit and identifying product and service value propositions, as well as uncovering customer/user needs to understand a path to commercial success. Her past experiences include group product director at J&J’s DePuy Spine, leading the strategic marketing and upstream marketing team, associate director for global commercial strategy in the MS Franchise at Biogen Idec, and current director of commercial strategy at Simbex. For more information, visit www.medtechstrategiesllc.com