With the digital medicine revolution in full swing, just about every specialty will experience some form of health care technology impact. AI algorithms, deep learning systems, and neural networks are already being used to detect lung cancer, screen skin lesions, and predict acute kidney injury. In the surgical realm, technological advancements previously involved the use of computer-assisted surgery (CAS) to improve precision and facilitate minimally invasive approaches. The da Vinci Surgical System obtained FDA approval in 2000 and, according to the company website, has been used in more than 6 million procedures world-wide. In orthopedics, CAS was introduced in the 1990s with perhaps joint replacement surgery as its most popular and widespread application. Despite the promise and potential of CAS to improve component positioning, few studies have demonstrated clinical benefit and the technology was largely abandoned. Due to improvements in technology and a focus on patient-specific surgery, there has been renewed interest in the use of CAS in orthopedics, this time in the form of robotics.
The rise of robotics in orthopedics can largely be traced back to MAKO Surgical Corporation, a medical device company founded in Florida in 2004. The system was initially used to perform partial knee replacements with total hip arthroplasty added a few years later. In 2013, Stryker acquired MAKO Surgical Corp. for $1.65 billion (and added the ability to perform knee replacements), thus taking robotic-assisted joint replacement surgery mainstream and kicking off a new round of competition in the already highly competitive world of orthopedic implant device manufacturing. Just recently, Zimmer Biomet introduced the ROSA Knee System, a robotic-assisted platform specializing in knee replacement innovation. Not to be outdone, Depuy Synthes is expected to introduce its robotic platform, currently named Orthotaxy, in 2020, also with a focus on knee replacement surgery. The company also announced a collaboration with Google to develop an advanced surgical robotics program. Other implant companies have also entered the robotics arena with Smith and Nephew leveraging Blue Belt Technologies platform to create its Navio System and UK-based Corin acquiring OMNI Orthopaedics Inc., a robotic-assisted knee replacement company. The rise of orthopedic robots shows no signs of slowing down with multiple startups including The Acrobot Company, 7D Surgical, Arthromeda, ROBODOC, Surgix LTD, THINK Surgical, Monogram Orthopedics and others all looking to bring automated solutions to orthopedic surgery.
The lure of robotics in orthopedics includes the ability to more precisely prepare bone and place implants with the goals of improving recovery, reducing complications, and obviating the need for expensive revision procedures. Robotic-assisted surgery represents an evolution of CAS and addresses some of the shortcomings that led to the failure of computer-based navigation, including improved ease of use, better preoperative planning capability, and enhanced intraoperative feedback. Surgical robotics in orthopedics can be viewed as an adjunctive tool to improve a physician’s ability to perform the procedure. Doctors, hospitals, health systems, and ambulatory surgical centers have also begun to view robotics programs as a means to differentiate themselves and offer cutting-edge technology to attract patients. Patients are now more educated about the options available to them and may be intrigued by the theoretical advantage of newer technology.
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