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Two studies using UK joint registry data found no significant difference in five-year implant survival between robotic and conventional hip or knee replacements. The findings come as the NHS plans to expand robotic surgery, while the studies do not resolve whether robotics improves outcomes such as pain or function.
Two studies of more than 2.5 million hip and knee replacements recorded in UK registries found no significant difference in five-year implant survival between robotic and conventional surgery. The findings bear on plans to expand robotic procedures in the National Health Service, where the technology adds substantial equipment and per-operation costs.
Researchers led by Hasan R. Mohammad of Queen Mary University of London compared procedures recorded from 2018 to 2024 in the National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey. The analysis included more than 2.5 million procedures, excluding Scotland. The two reports were published in The BMJ, one examining hip replacements and the other knee replacements.
The researchers matched patients who received robotic surgery with similar patients who received conventional surgery, accounting for clinical and demographic factors and surgeons’ procedure volumes. In the matched groups, five-year implant survival was 98.8% for both robotic and conventional total hip replacements. For total knee replacements, it was 98.6% with robotics and 98.5% with conventional surgery. For partial, or unicompartmental, knee replacements, survival was 96.4% and 97.8%, respectively.
Results were broadly similar in comparisons of the full, unmatched populations. The studies found no significant differences in knee complications or specific reasons for revision. In an unmatched hip comparison, revisions for dislocation and some fractures were less common after robotic surgery; those differences were no longer statistically significant in the matched groups. The hip analysis also found no significant difference in all-cause mortality.
Costs Meet the NHS Expansion Plan
The studies challenge the expectation that robotic assistance will reduce revisions by improving implant positioning. The authors cited estimates of roughly £1 million per robotic device and an additional £1,000 to £2,500 per procedure. With no significant survival advantage detected over five years, health systems face a question about whether those extra costs are justified by other benefits.
The timing matters in Britain: a government 10-year plan published in July calls for the NHS to increase sevenfold the proportion of hip and knee replacements performed with robotic assistance. The plan says expansion will align with guidance from the National Institute for Health and Care Excellence, which evaluates medical technologies, including their cost-effectiveness. The new results may inform that assessment, but do not by themselves settle it.
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What the Registry Comparison Measured
Robotic systems are used to assist surgeons in planning and placing joint implants. Their proposed benefit is more accurate positioning, which could reduce problems such as malalignment and loosening that can lead to revision surgery. Revision rates provide one measurable outcome, but they do not capture every aspect of recovery.
The registry analysis covered conventional and robotic total hip replacements, total knee replacements and unicompartmental knee replacements. The matched comparisons included nearly all patients who had robotic procedures, with up to four conventional-surgery patients matched to each robotic patient. Most knee operations and more than 90% of hip replacements in the study were for osteoarthritis.
“The observational design of the study means we cannot rule out the possibility of unmeasured and residual confounding.”
— Hasan R. Mohammad and colleagues, in their reports in The BMJ
Benefits Beyond Implant Survival
The studies focused on revision and implant survival, so they do not establish whether robotic procedures improve pain, stiffness, function or joint wear. Nor can an observational registry comparison eliminate the possibility of residual confounding, despite the matching process. The authors also noted that most operations took place in the NHS, so findings may not apply in the same way to other health systems.
Some advantages appeared in unmatched hip data, including fewer revisions for dislocation and fewer acetabular and femoral fractures, but these differences were not statistically significant after matching. The available findings do not show whether those signals reflect a real effect.
NICE Guidance and NHS Rollout
The NHS plan calls for robotic surgery expansion beginning next year, in line with NICE guidance. NICE’s evaluation will be a key point for deciding how the registry findings and the technology’s added costs factor into that rollout. The source material does not state when NICE will issue or revise any guidance in response to the studies.
Further evidence on patient-reported recovery and longer-term outcomes could help answer questions left open by five-year revision data. For now, the studies show similar implant survival in the procedures and populations they examined.
Key Questions
Did robotic joint replacement improve five-year implant survival?
The studies found no significant difference between robotic and conventional surgery for total hip, total knee or unicompartmental knee replacements in the matched comparisons.
How many procedures were included?
The researchers analyzed more than 2.5 million procedures recorded from 2018 to 2024 in the UK National Joint Registry, excluding Scotland.
Did the studies show robotic surgery has no benefits?
No. They did not find a significant survival advantage, but they did not resolve whether robotics affects outcomes such as pain, stiffness or function. Some differences in hip complications appeared in unmatched data but were not significant after matching.
Why do the findings matter to the NHS?
The NHS has announced plans to increase the share of hip and knee replacements performed with robotic assistance sevenfold. The studies’ results and estimated additional costs may inform NICE guidance on the technology.
Source: rss
