Risks and Complications of Autonomous and Semiautonomous Robotics in Joint Arthroplasty

Abstract

Robotic systems have been introduced in orthopedic surgery to improve clinical outcomes. While there may be improved accuracy and decreased risk of outliers with robotic systems, there are also drawbacks to the usage of robot assistance. The main risks of the use of autonomous and semiautonomous robotic systems in joint arthroplasty are radiation exposure, pin-related complications, registration malfunction, potential soft tissue damage, and longer operating times. Image-based systems require a preoperative CT scan to pre-plan the surgery; therefore, patients are more exposed to radiation compared to conventional joint arthroplasty. Robot assistance relies on accurate registration of anatomic surface landmarks, using pins with reference arrays and markers. Registration malfunction may occur because of abnormal anatomy or system-related issues (e.g., software or marker dysfunction). Unnecessary soft tissue damage is another risk associated with the use of robotic systems, as the system only tracks bone and not soft tissues. Therefore, muscles and ligaments around the joint must be protected during the procedure to prevent damage, as is suggested by several studies. Finally, current literature shows that operating times are extended with the use of robot assistance, particularly with regard to total joint arthroplasty.