JBJS - 2026-09-15 - Journal Article
Robotic Arthroplasty in Context: Balancing Evidence and Innovation in Joint Replacement.
Fraval A, Rajgopal A, Bozic KJ, Bhandari M, Parvizi J
Topics
Key Takeaway
Robotic-assisted arthroplasty consistently improves component positioning precision but has not demonstrated improvements in patient-reported outcomes, complication rates, or implant survivorship across systematic reviews, meta-analyses, RCTs, and national registry data.
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Summary
This narrative review synthesizes evidence from RCTs, meta-analyses, and national registry data on robotic-assisted THA and TKA. Robotic systems reliably improve component positioning accuracy and reproducibility, but no consistent benefit in patient-reported outcomes, complication rates, or implant survivorship has been demonstrated. The authors identify statistical fragility, platform heterogeneity, and a science-to-adoption disconnect as critical barriers to interpreting the existing literature.
Key Limitation
As a narrative review without a registered protocol or systematic search strategy, it cannot quantify effect sizes, assess publication bias, or definitively resolve whether subgroups of patients or specific robotic platforms yield differential benefit.
Original Abstract
➢ This review examines the contemporary evidence surrounding robotic-assisted joint replacement, including its effects on surgical precision, clinical outcomes, and implant survivorship, and the broader implications for innovation in arthroplasty.➢ Current evidence consistently demonstrates that robotic-assisted arthroplasty improves the precision and reproducibility of component positioning. However, systematic reviews, meta-analyses, randomized trials, and national registry data have not demonstrated consistent improvements in patient-reported outcomes, complication rates, or implant survivorship.➢ The existing literature is limited by statistical fragility, heterogeneity among robotic platforms, and a disconnect between scientific evidence and public enthusiasm.➢ Future value may lie in the integration of robotics with large-scale data acquisition and data-driven personalization, although these concepts remain largely unproven.➢ The experience of robotic-assisted arthroplasty highlights the need for a more rigorous evidence-based framework for innovation in orthopaedic surgery, with adoption guided by demonstrable improvements in patient outcomes and health-care value rather than technical precision alone.