Rise of the robots in knee replacement surgery– are surgeons soon to be redundant?

Dr John Gallagher, one of Brisbane’s most respected names in knee replacement has raised the
question of whether technology may be putting him and his colleagues out of a job as patients
are increasingly requesting knee replacements with robotic assistance.

As Australia’s population ages with a predicted life expectancy in 2050 of 86 years, arthritis is
prevalent, affecting around 2.75 million Australians. In addition to ageing, in 2024, 66% of all
Australians were either overweight (34%) or obese (32%) which has steadily increased by 10%
since 1995. With this trend of increasing life expectancy and obesity, a more than 50% increase
in osteoarthritis is expected by 2032. In keeping with this, the most recent 2024 report from the
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) revealed
that nearly 70,000 total knee replacement (TKR) procedures were performed in 2023, which was
a 20.7% increase from the previous year.

“Knee arthritis and TKRs are likely to be an increasingly important part of our national health care
in the years ahead,” said Dr Gallagher. “And whilst TKR surgery in general terms has a high
success rate in relieving pain, restoring mobility and function, some studies have reported as
many as 20-30% of patients being unhappy following TKR. My question is, how do we improve
satisfaction rates and is robotic surgery a part of that?”

Dr Gallagher feels that the education of patients about the realistic limitations of TKR is the first
step in avoiding dissatisfaction, but from a surgical viewpoint, ongoing efforts to try to achieve
the “perfect” TKR continues to evolve, with improved implant design, more anatomically shaped
implants, more size options, and more durable lower wearing prostheses to help them last
longer.

“One of the recent advances which helps to quantifiably measure implant position, lower limb
alignment, soft tissue envelope tension and balance throughout knee range of motion has been
the advent of robotic surgery. The first robotic assisted TKR in Australia was performed a decade
ago in 2016, since which time nearly 72,000 have been performed,” said Dr Gallagher.

There are five robotic systems available, with Dr Gallagher having practical experience using
three including the ROSA, MAKO and CORI systems. According to Dr Gallagher, they all provide
real time feedback on both implant positioning and soft tissue tension allowing minor changes
or “fine tuning” in implant position or soft tissue releases to achieve what he believes to be the
“perfect compromise” of implant position, lower limb alignment and soft tissue tension and
balance for each individual patient.

Whilst long term studies are limited, no demonstration of superiority of one robotic platform over
another or traditional techniques yet exists however the most recent AOANJRR 2024 Report did
demonstrate that TKRs performed with robotic assistance had fewer revisions for loosening and
instability. It also demonstrated for the first time that of the four methods available for
performing TKR, in 2023 robotic assisted technique was now the most common at 35.7%,
traditional technique with alignment jigs at 31.5%, computer navigated at 21.4% and image
derived instrumentation at 11.4%.

“So does this mean early retirement?” jokes Dr Gallagher . Not quite, he believes. “ Whilst I feel
it is a useful tool, the robot alone is not enough. There are times where, based on experience, I
have overridden the robot and understand like any technology, such as a car navigation system
that may steer a car in the wrong direction, or a plane where the autopilot isn’t enough, the
surgeon needs to remain ever alert and ready to take the wheel. As such, I feel it’s unlikely to
make surgeons redundant any time soon.”

Robotic assisted TKR technique is now widely accepted and has demonstrated over a large
number of Dr Gallagher’s procedures to have at least equal results with all other methods and
potential for a lower revision rate for loosening and instability. His patients who have undergone
TKR with robotic assisted technique have also largely required less post operative analgesia, had
shorter hospital stays and achieved very good lower limb alignment and flexibility.

Written by Dr John Gallagher

Dr John Gallagher is a leading Orthopaedic Surgeon with over two decades of experience in knee
surgery. The combination of Dr Gallagher’s extensive experience, his use of state of the art technology including robotic assistance and computer navigation along with personalised care and clear communication, helps to optimise every patient’s surgical journey.

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