The edition · Orthopaedics
Robotic knee replacement adds operating time, not function, across 24 randomised trials
A trials-only meta-analysis finds no functional or pain benefit from robotic TKA; an articulating spacer keeps 89% of infected hips reinfection-free at five years; and AI assistance lifts fracture detection most for junior doctors.
The edition in brief
Four studies for orthopaedic surgeons. A meta-analysis of 24 randomised trials (3,425 patients) found no difference between robotic-assisted and conventional total knee arthroplasty in change in WOMAC function (MD 0.14, −5.88 to 6.16), Knee Society Score or Oxford Knee Score, pain, range of motion or stay, while robotic cases took about 22 minutes longer; certainty was low to very low. In 302 two-stage revisions for infected hip arthroplasty using an articulating high-dose antibiotic spacer, 5-year survival free of reinfection was 89% and free of any reoperation 80%; spacer dislocation raised the risk of dislocation after reimplantation (HR 6.2). A diagnostic meta-analysis of 17 studies found AI assistance raised fracture detection sensitivity from 73% to 87% with specificity unchanged, with the largest gain (21 points) in junior clinicians. In 243 patients followed at least 10 years after hip arthroscopy for impingement, those with psychiatric comorbidity failed more often (23.3% vs 5.3%). The pearl covers screening for anxiety and depression before elective hip arthroscopy.
Articulating antibiotic spacer: 89% of infected hips free of reinfection at five years
If the spacer dislocates, plan a more stable construct at reimplantation — the risk of later dislocation is about six times higher.
AI assistance lifts fracture detection sensitivity from 73% to 87%
AI support catches more fractures without more false alarms, most of all for junior clinicians — but occult fractures still need cross-sectional imaging.
Anxiety and depression linked to failure 10 years after hip arthroscopy
Screen for anxiety and depression before hip arthroscopy and set expectations accordingly.
Two questions before listing an elective hip arthroscopy
Ask the PHQ-2 and GAD-2 questions before listing elective hip arthroscopy.
Robotic TKA matches conventional TKA on function and pain, and takes longer
Robotic TKA offers no functional or pain advantage over conventional TKA in randomised trials, at the cost of longer operations.
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