OTSR - 2026-07-25 - Journal Article; Review
What Would Be the Ideal Robotic Companion in Orthopaedic Surgery in 10 Years?
Fogacci A, Kouyoumdjian P, Selmi TAS, Putman S, Jacquet C, Lustig S
Topics
Key Takeaway
Robotic-assisted TKA improves implant positioning accuracy but has not demonstrated consistent improvement in patient-reported outcomes or implant survivorship, and the next decade of development should prioritize five unmet clinical domains over additional precision.
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Summary
This narrative review examines current robotic-assisted orthopaedic surgery capabilities and limitations, then defines five priority development domains for the next decade: smarter planning/decision support, simplified workflow, intraoperative soft-tissue and biomechanical assessment, patient-specific adaptability, and surgical education integration. The authors identify a persistent gap between technical execution accuracy and clinical outcome improvement as the central problem driving future development priorities. Realizing the proposed advances requires clinical validation, cost-effectiveness data, and resolution of ethical and medicolegal concerns.
Key Limitation
As expert opinion without systematic methodology or quantitative data, the five proposed development domains reflect author perspective rather than evidence-derived priorities, limiting generalizability and actionability.
Original Abstract
BACKGROUND
Robotic-assisted surgery is now an established part of contemporary orthopaedic practice, particularly in knee arthroplasty, where it has reliably improved the accuracy and reproducibility of implant positioning and bone preparation compared with conventional techniques. Better technical execution, however, has not consistently translated into better patient outcomes or implant survivorship, suggesting that the next decade of development may depend less on additional precision than on addressing clinical needs that remain unmet.
PURPOSE
To examine the current strengths and limitations of robotic-assisted orthopaedic surgery and to define, from the surgeon's perspective, the characteristics of an ideal robotic companion over the next decade across five domains: smarter planning and clinical decision support, simpler workflow and wider accessibility, better intraoperative assessment of soft tissues and biomechanics, greater patient-specific adaptability, and integration into surgical education.
METHODS
Narrative review of the current literature on robotic-assisted orthopaedic surgery, with particular focus on total knee arthroplasty and on emerging enabling technologies.
RESULTS
Progress in artificial intelligence, imaging analysis, augmented reality, sensor technologies and simulation could extend the robotic role well beyond surgical execution, towards planning, intraoperative decision support, patient-specific adaptation and training. Realising this potential will require solid clinical validation, improved cost-effectiveness, smooth workflow integration, and careful attention to the ethical and medicolegal questions these systems raise.
CONCLUSION
A robotic companion should never replace surgical judgement; its role is to provide clinically meaningful information that helps surgeons decide better, tailor treatment and improve care. Future systems should be judged on clinical grounds rather than technical sophistication - not by how advanced they are, but by whether they solve the problems surgeons and patients actually face.
LEVEL OF EVIDENCE
V; Expert opinion.