Digital and robotic MSK surgery: is this the moment?

[...]two major types of robots in orthopaedic surgery have been classified: systems that can deliver direct or indirect surgery and can be autonomous or non-autonomous.20 Direct systems involve a robotic arm cutting bone to a predefined surgical plan, whereas indirect robots, such as navigation systems, facilitate placement of cutting jigs for the surgeon to perform bony cuts manually. Overall, the long-term evidence for robotic surgery improving survivorship and functional outcomes is weak, but Kayani et al have shown that short-term outcomes such as blood loss, pain scores and hospital length of stay can be reduced with robotic unicompartmental arthroplasty.4-6 Systematic reviews and meta-analyses show robotic surgery can improve the accuracy of implant positioning over conventional methods.7-9,11 The pre-planning associated with RAS (such as preoperative computed tomography scans with computer navigation) now allow robotic arms to execute individualised procedures that better restore the native alignment and anatomy of the patient.24-26 Unfortunately, with this comes extra radiation for the patient and potentially other unwanted complications. There are numerous examples of overenthusiastic adoption of surgical innovation in our recent history, such as the metal-on-metal hip replacement.30 Real-world concurrent evaluation with roll-out should be entertained as a method of evaluation for this fast-changing area. [...]patient safety and quality of surgery must remain paramount in the development of these new technologies and when training future surgeons.