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Kill the Robots?

by Elizabeth Hofheinz, M.P.H., M.Ed., December 19, 2019

If tech is sexy then robots should be wearing garter belts.

But, says one total joint surgeon…look away.

“Although robotics are the hottest and latest thing, they are primarily industry-driven. There is little to no science to support their use in hip and knee replacement, and the majority if not all of the evidence supporting its benefits are from surgeons with industry bias. We have almost no data indicating that there is any benefit to surgeons or patients—it is all theoretical benefits at this point in time and driven solely by marketing. Everyone knows that it slows down the surgical process, consumes more resources and costs more. In my opinion doctors are just doing it to market their practices and it is particularly prevalent in certain markets with heavy concentration of robots having been purchased by hospitals with the sole purpose of attracting patients. Although we have never been able reign in things like this in our profession, it is increasingly likely that robotics will eventually burn itself out due to the unsustainable lack of efficiency and high cost.”

And the “burnout” may be underway. “When companies have earnings calls these days they talk about ‘units placed’ rather than ‘units sold’ because the market is gradually becoming saturated and the appetite is waning for high cost capital expenses of unproven technology in the currently healthcare environment. They are shifting them around or providing them with implants and combined incentives to offset the cost of the robot. Hospitals are wasting their time, paying a million dollars in hopes of attracting doctors and patients. And for what?”

Asked what he tells young surgeons, this orthopedic surgeon noted, “I have a fellow from a program that is heavy on robotics. He actually ranked our program as one of the highest because we don’t do robotic training. I want to make sure that trainees know that there is no backup in case the robot fails. These things happen every day and cause major problems. One company just recalled its robot due to programming errors. And what about infection rates when robots are used…we have no information on that.”

“I have told industry representatives that their robots only have value when they identify the appropriate target and I also feel robotic technology can make low-volume or surgeons with below average skill better. However, there is some research indicating that accuracy in the hands of an experienced and high-volume surgeon is just as good, and in some cases, better, than a robot. With respect to surgeons getting compensated for the additional time required for robotic technology, it is plausible that will come in time.  Those who led the charge to get reimbursement for navigation did succeed; now certain industry people want a code for robotics. Fifteen years later navigation has not been shown to move the needle terms of outcomes. Robotics will likely be no different.”

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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