Incorporation of Robotics in Orthopedics

Robots are widely used in all fields due to their high precision and repeatability during procedures that require fine movements and accuracy. Incorporating robotics into orthopedics shows a transformative paradigm shift and impacts the diagnosis, treatment, and rehabilitation domains. The introduction of robotics in orthopedics has shown a major turning point in the evolution of medical technology, changing traditional medical techniques into exact and customized procedures. Also, it helps to enhance accuracy and patient outcomes.

Traditional orthopedic interventions and diagnostic methods have several drawbacks, such as being invasive, having poor accuracy and precision, causing post-operative pain, requiring a lengthy recovery period, causing blood loss, exposing patients to high doses of anesthesia, requiring longer hospital stays, causing patient morbidity, leaving large surgical wounds, and carrying a high risk of infection. These drawbacks make the use of robotics in orthopedics necessary.

The use of robotics in orthopedics has many benefits, including the ability to perform intricate tasks that are difficult for the human hand with the aid of robotic arms, a robotic platform that allows surgical techniques to be customized based on the anatomy of the patient, accurate implant positioning, decreased radiation exposure and fluoroscopy requirements, improved precision, and fewer incisions needed, which minimizes tissue disruption and pre-operative pain.

Robotics is useful in several fields of orthopedics, such as knee, hip, shoulder, spine, foot & ankle, and trauma & general orthopedics. A few significant robotic procedures in the following fields are listed here:

The technological advancements in orthopedic robotics address several important unmet needs in orthopedic interventions. These advancements play a crucial role in improving patients’ lives by making the procedure accurate and less time-consuming. Here are some recent developments in the field of orthopedic robotics technology:

• Artificial Intelligence: Artificial intelligence-based total knee replacement robotic systems utilize AI algorithms to analyze patient anatomy to design a customized surgical plan. Also, the system will allow real-time adjustments during surgery. Integration of AI and robotics provides improved accuracy in implant positioning.
• Augmented Reality: The AR-assisted surgical spine robot provides real-time guidance for surgical screw insertion, where the headset displays information related to the patient, which helps to execute the surgical procedure with high precision. 
• Mixed Reality: A mixed reality-based guidance system helps to enhance accuracy during procedures such as shoulder arthroplasty, which may lower the incidence of implant-related problems and revisions.
• Miniaturization: A handheld, small robot compensates for the surgeon’s hand movement and allows surgeons to automatically place pins on a predefined plane. The small robot is used for knee surgery. The system optimized the data transfer step with Wi-Fi and Bluetooth. 
• Mobile Robotic Platform: This mobile robotic platform is equipped with a robust robot navigation and safety stack. The robot has a virtual face, displays correction recommendations on its screen, and has a voice output system to improve the robot-patient interaction during training sessions. It generates a skeleton model of the patient with 32 joint and support points.

The adoption of robotic systems in the field of orthopedics has increased in recent years. The innovations in robotics in the orthopedics domain help to implement technologies that deliver accurate, customized treatment. A few recent trends in the field of orthopedic robots are listed below:

• Advanced Navigation: Integrating advanced software with sensor technology to develop a 3D model of patient anatomy to guide the surgeons during the surgical procedures.
• Smart Glass in Joint Replacement Surgery: A humanoid hybrid robot is used for joint replacement surgery combined with smart glasses that integrate artificial intelligence and virtual reality to improve patient outcomes and surgical precision.
• Soft Robotic Rehabilitation Gloves: Gloves are used by individuals with hand disabilities or injuries to improve hand and finger strength and range of motion. Advanced robotics technology assists with hand exercise, helping users regain strength in the hands and fingers.
• AI-based Robotic Exoskeleton: Advanced and lightweight exoskeleton wearable robots assist with the lower limbs, allowing patients to gain mobility and independence. Integration of AI makes the exoskeleton more responsive to user movements.

The market for orthopedic robotics is anticipated to expand due to advancements, demand, and applications. Due to several causes, such as the rise in orthopedic issues such as osteoarthritis, ligament tears, hip and knee fractures, and joint pain, and the need for safer, faster, more precise, accurate, and user-friendly minimally invasive procedures, the market is expanding rapidly. Therefore, several big players, start-ups, and universities are working in a particular field:

However, a few factors impeding the growth of the orthopedic market are stringent regulatory restrictions and a lack of knowledge of robotic equipment.

FDA approval is important for orthopedic robotic systems for several reasons, like ensuring safety and efficiency, building trust and credibility, facilitating market access, insurance reimbursement, post-market surveillance and continuous improvement, legal and liability protection, and international acceptance.

The orthopedic robotics market is attracted by several start-ups that aim to revolutionize surgical procedures and patient care. These start-up companies are working to overcome the limitations in orthopedic surgery by integrating various cutting-edge technologies like AI, 3D printing, and robotic assistance to improve precision and reduce recovery times.

• Capsix Robotics: An AI-based massaging robotic arm for orthopedic physiotherapy.
• Caira: A robotic solution for knee replacement therapy that integrates radar-based tracking technology.
• Te Diro: A mobile robotic platform for gait training that integrates artificial intelligence and cloud-based technology.
• H-Robotics: Smart robotic rehabilitation solution that provides motion to the elbow, wrist, ankle, and knee joint.

Numerous robotic systems are being introduced in various orthopedic treatments due to technological breakthroughs and the demand for robotic systems in orthopedic interventions. A few orthopedic robotic systems that have recently been introduced are listed below:

• In 2023, Caira launched the TKA radar navigation system, which integrates advanced joint replacement software with precision radar technology.
• In 2023, CMR Surgical launched a small, modular, and portable surgical system called the Versius® Surgical Robot System in Belgium.
• In 2022, the Mako Robotic Arm was launched for total knee arthroplasty (TKA) and partial knee replacement surgeries, which enhances precision and reduces post-operative pain.
• In 2021, DePuySynthes launched Velys Robotic-Assisted Solution in the US for knee surgery; later, in 2023, the system was launched in the European market as well.

The orthopedic robotic market is expanding favorably as a result of mergers, acquisitions, partnerships, and collaboration between big players, start-ups, and universities. The following are some recent events that took place in a specific field:

• In February 2024, Think Surgical collaborated with Maxx Orthopedics to develop robotic total knee arthroplasty (TKA) systems. This collaboration aims to integrate Maxx Orthopedics’ implants with Think Surgical’s ID-HUB.
• Think Surgical collaborated with b-ONE Ortho in February 2024 to add b-ONE Ortho implants, including the MOBIO Total Knee System, to THINK Surgical’s ID-HUB.
• In April 2022, Community Memorial Hospital launched a robotic surgery program in partnership with Hamilton Orthopedics Spine and Sports Medicine with the VELYS Robotic-Assisted solution.
• In September 2023, Stryker and Zimmer Biomet developed the MAKO Surgical System for joint replacement and spine procedures. These systems provide advanced imaging and real-time feedback.
• In April 2022, Yale University and Johns Hopkins University came together to explore personalized medicine, implant design, and robotic 3D planning to improve the precision and efficiency of joint replacements.

Although orthopedic robotics offers many benefits, some difficulties arise when using robotics in orthopedics. Below are a few of the challenges raised by orthopedic robots and their corresponding solutions.

The use of cutting-edge technologies improves the standard of orthopedic robotic treatments and consequently enhances patient outcomes. A few of the technologies listed below could propel the orthopedic robotics market in the future:

• Nano or Micro Robots: Robots are designed to carry out specific activities at the nano or micro scale level to enhance the precision and effectiveness of orthopedic operations.
• Motion-capture System: Robotics can be used in postoperative rehabilitation to optimize mobility and strength recovery through the use of an xoskeleton and motion-capture system.
• Mobile Ankle-Foot Exoneuromusculoskeleton: Specifically designed for stroke patients with hemiplegia, it improves the motor function of their lower limb and walking ability.
• Digital Twin Creation of Spinal Surgery: Focuses on the acquisition and modeling of the geometry and appearance of the entire spinal surgical scene for training, education, surgical planning, and automation of surgical tasks.
• Artificial Intelligence of Medical Things (AIoMT): Integrates the capabilities of artificial intelligence and the Internet of Medical Things, which helps enhance the analysis.