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Health

Robotic surgery offers no clear benefit over conventional joint replacements, major BMJ studies find

Two major BMJ studies of more than 1.3 million joint replacements found robotic-assisted hip and knee surgery offers no clear benefit over conventional surgery, casting doubt on NHS plans for a sevenfold expansion.

By Sarah Whitfield · · 1 min read

A surgeon seated at the console of a da Vinci Xi surgical robot, operating its controls.
Navy Medicine, US Navy (public domain)

Robotic-assisted hip and knee replacements offer no clear benefit over conventional surgery, according to two major peer-reviewed studies published in The BMJ on 30 September — the largest real-world evaluation of the technology to date.

Researchers at Queen Mary University of London, the University of Oxford and the University of Bristol analysed National Joint Registry data covering 666,283 total hip replacements (656,080 conventional, 10,203 robotic) and 697,145 total or partial knee replacements (675,034 conventional, 22,111 robotic) performed in UK hospitals between 2018 and 2024.

Using propensity score matching and adjusting for age, sex, body mass index, diagnosis, fitness, implant type and surgeon volume, the team found no differences in implant survival, overall or cause-specific revision risk, or complications during surgery over about 2.5 years of follow-up. Robotic surgery was, however, linked to fewer hip revisions related to implant malpositioning.

The authors stress the studies are observational, so no firm causal conclusions can be drawn, and longer follow-up is needed. Functional outcomes will be addressed by the ongoing RACER trials.

The results question the NHS plan to expand robotic surgery sevenfold by 2035, given costs of around £1 million per system plus £1,000–2,500 extra per patient. ‘These results highlight the importance of careful evaluation of robotic technology in publicly funded healthcare systems, given the substantially higher capital and procedural costs involved,’ the authors conclude. The National Institute for Health and Care Excellence had called for urgent research into the effect of robotic surgery on revision risk.

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