Currently some shoulder surgeons are considering the value of robotic technology in their arthroplasty practice. Incentives for the use of robotics could include the belief that it will improve patient outcomes, marketing and competitive positioning, industrial financial relationships, higher reimbursement codes, speaking opportunities, and professional advancement.
A general rule in the consideration of advanced technologies, such as robotics, is for the individual surgeon to ask: "does the new technology solve a problem I have in my practice?" Answering this question requires the surgeon to take a critical view of cases that failed to meet expectations, and deciding whether the use of robotics would have significantly reduced the risk of these failures. Different surgeons will reach different conclusions based on their experience and practice.
A recent article, Robot-assisted shoulder arthroplasty is a helpful review of robotic-assisted shoulder replacement. Here are some takeaways from that article along with some additional thoughts for consideration.
Robotics excels in industry - for example in automotive assembly lines- where the desired geometry is accurately defined, the space is plentiful, the exposure is constant, the quality of the materials is standardized, the planning is fixed for all cases, exactly the same step is repeated over and over, the robot is programmed to avoid collateral damage to nearby structures, there is no concern for sterility, different robots perform the procedure identically, the human factor is eliminated, haptic feedback is unnecessary, and quality control is straightforward. None of these conditions exist in shoulder arthroplasty.
As the article notes, available robots differ substantially and "details regarding robotic shoulder arthroplasty are largely safeguarded information at this point and difficult to learn due to intellectual property protection." Common features include added direct and indirect costs, learning curves, potential complications regarding insertion of the array to align the robot with anatomical landmarks, increased space requirements (e.g. may be a tight fit in a surgicenter), and like all machines, susceptibility to malfunction. Robotics requires additional OR time, personnel, and sterilization protocols. Robotic planning is based on CT scans with up to a 1,000 times increase in radiation exposure compared to plain films of the shoulder.
The literature demonstrates that robotics can increase the precision with which baseplate positioning matches a preoperative plan, especially in laboratory models. The literature does not answer the harder questions: (1) how much placement precision is needed for a good clinical result from RSA, (2) are the patient outcomes clinically significantly better than for reverse shoulder arthroplasty performed without robotics? (3) does the use of robotics reduce the risk of the common complications of RSA, such as infection, component loosening, instability, acromial/scapular spine fractures, and periprosthetic fracture? and (4) is robotic reverse shoulder arthroplasty of value for the typical shoulder surgeon who performs fewer than ten of these procedures per year.
Answering such questions will require clinical outcomes research comparing robotic and non-robotic RSA, carefully controlling for surgeon experience with both approaches and patient selection (avoiding, for example, a bias toward robotic RSA for younger, healthier patients). Outcome variables will need to include patient reported outcomes, revision rates, and complications. Given the substantial economic implications, transparent disclosure of potential conflicts of interest will be essential in interpreting the emerging literature.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
