1) Artificial intelligence was first proposed in 1956 and aims to reproduce human intelligence using computers. AI has made improvements in medical imaging through techniques like deep learning and neural networks. 2) Robotic systems in orthopedic surgery are classified as haptic or active. Haptic systems require surgeon guidance while active systems follow a preoperative plan without intervention. 3) Studies have shown that robotic-assisted joint replacements can achieve better alignment and reduce operation time and blood loss compared to conventional techniques. However, the benefits of AI and robotics in orthopedics require further long-term studies.

1. AI -from Hype to
Ripe!!-Is it just
The Bandwagon
effect!!!
Mr Nagaraj, Prashanth
MBBS, MS(ORTHO), MRCS Ed, FRCS Ed(Tr
&Orth)
BOFAS Fellow –Foot and ankle-(Avon
orthopaedic centre-Bristol)

2. Artificial intelligence (AI), first
proposed by Prof. John McCarthy in
1956, aims to reproduce human
intelligence using computers
AI techniques have made great
improvements in every step of the
medical imaging pathway, from
acquisition and reconstruction to
analysis and interpretation .By
incorporating information from the
patient’s medical records (including
symptoms, laboratory results, and
physical examination findings), AI
identifies the most appropriate
patient-specific imaging examination
and determines the most
appropriate protocol

3. • The concept of AI was first introduced in 1956 by Prof.
John McCarthy, an American computer and cognitive
scientist at Dartmouth College,
The main principle was based on the following assertion:
computers could precisely mimic cognitive functions of
human beings such as learning and problem solving.
The AI concepts, deep learning and artificial neural
networks became the cornerstones of significant
achievements in image processing. These concepts
stimulate neural networks of the human brain and cluster
the images.

4. • Robotic systems are mainly classified into two
categories: haptic and active.
• Haptic (surgeon-guided) systems consist of
user’s physical manipulations to increase the
success rate of operation.
• Active or autonomous systems follow a
complete preoperative plan and surgery is
carried out without the surgeon’s intervention

5. Artificial intelligence
(AI) provides machines
with the ability to
perform tasks using
algorithms governed by
pattern recognition and
self-correction on large
amounts of data to
narrow options in order
to avoid errors

6. The 4 things necessary for AI in
medicine include
1)big data sets
2)powerful computers
3) cloud computing
4) open source algorithmic
development.
The use of AI in health care
continues to expand, and its impact
on orthopaedic surgery can already
be found in diverse areas such as
image recognition, risk prediction,
patient-specific payment models,
and clinical decision-making.
AI could provide solutions to factors
contributing to physician burnout
and medical mistakes. However,
challenges regarding the ethical
deployment, regulation, and the
clinical superiority of AI over
traditional statistics and decision-
making remain to be resolved.

7. • Orthopaedic surgery began to
incorporate robotic
technology in 1992, with the
introduction of the ROBODOC
system for the planning and
performance of total hip
replacement
• Substantial progression has
been made in the use of
robots in the past few years.
Most orthopaedic robots, such
as the Mako system, are used
for joint replacements such as
unilateral knee arthroplasty,
total knee arthroplasty, and
total hip arthroplasty
“studies have shown that the robots are
superior to the conventional technique in
achieving limb alignment and reducing
operation time and blood loss”

8. • The ROBODOC system (Curexo Technology, Fremont,
CA, USA) was the first robotic system used in
orthopedic surgery in 1992. It was originally an active-
autonomous, image-based, robotic system which
allowed the surgeon to plan the femoral side for
component implantation and to assist surgery in
cementless total hip arthroplasty (THA)
• However, the incorporation of this technology was
limited due to its technical complexity, increased
operative time, and insufficient versatility

9. Robodoc

10. MAKO

11. • The RIO® Robotic Arm Interactive Orthopedic
System (MAKO Surgical Corp., Lauderdale, FL,
USA) is a haptic robotic system that requires
active participation of the surgeon and assists the
surgeon in knee arthroplasty.
• It creates a three-dimensional model of the
patient’s anatomy, enabling the surgeon to
develop a preoperative plan. These systems
provide navigation during surgery thanks to the
pins placed in the femur and tibia. The rotating
burr allows the RIO robotic arm to resect bone.

12. CUVIS-joint Surgical System

13. • The CASPAR (Ortho- Maquet /URS, Schwerin,
Germany) was another early autonomous system.
It was an image-guided, active robot used for THA
and total knee arthroplasty similar to ROBODOC
• Operating time for these first 70 cases averaged
135 min, but decreased to approximately 90 min
at the end of the study, which was approximately
equal to the control group. No major adverse
events related to the CASPAR system were
reported

14. • Most studies about spine surgery have
evaluated the Renaissance robot and the Rosa
robot. Several studies have proven that the
robots have the advantages of improved
pedicle screw accuracy and reduced radiation
exposure for patients and clinical staff
compared with conventional surgery

16. Tianji robot
• In 2016, we presented the TianJi
Robot, which is a multi-
indication orthopedic surgical
robot that can be used for all
levels of spinal instrumentation
and pelvic,acetabular,and limb
fracture surgeries.
• The TianJi robot combines a
robotic arm with a real-time
navigation system and has a
high degree of surgical precision
Compared with free hand
surgery, the TianJi robot
significantly improves the
accuracy of instrument
placement and improves the
clinical results
• .

17. Telerobotic Spinal Surgery Based on 5G
Network: The First 12 Cases
Wei Tian,1,2 Mingxing Fan,1 Cheng Zeng,1
Yajun Liu,1 Da He,1 and Qi Zhang1
Remote surgery is based on the mutual
telecommunication of medical information.
Medical information, such as image, audio, and
video, are digitized and transmitted via cable
or wireless telecommunication networks.
Surgeons can manipulate the surgical robot to
perform operations from a distance via the
networks
In July 2019, Prof. Wei Tian performed the
world’s first multi-centre the 5th generation
(5G) remote orthopaedic surgery using 5G
technology. The combination of 5G technology
and robotic technology improves the safety
and quality of remote surgery, and maybe the
future of remote surgery

19. Equipment and Personnel Arrangement of 5G Telerobotic Spinal Surgery
The 5G network: telecommunication network and equipment were
provided and established by China Telecom (Beijing, China) and Huawei
Technologies Co., Ltd. (Shenzhen, China).
Equipment and personnel arrangement in hospitals with patients
underwent operations (the patient side): surgical robot system (TiRobot
system), C-arm, carbon fiber operating table, high-definition cameras
and monitors, surgeons, and robot engineers. Local surgeons placed K-
wire and screws, supervised the movement of the robot, and
performed decompression if necessary. Robot engineers set up the
navigation and took 3-dimensional images for registration or
verification.
Equipment and personnel arrangement in the master control room
located in Beijing Jishuitan Hospital: multiple monitors, high-definition
cameras, robot workstation, audio equipment, the leading surgeon,
and network engineers. The leading surgeon performed screw planning
and robot manipulation.

20. There were 6 hospitals from 6 different cities in
China involved in these clinical case series:
Beijing Jishuitan Hospital (the telesurgery center
where the master control room located),
Shandong Yantaishan Hospital, Zhejiang Jiaxing
Second Hospital, Tianjin First Central Hospital,
Hebei Zhangjiakou Second Hospital, and Xinjiang
Karamay Central Hospital.

21. Limitations!!
• AI has revolutionized the face of modern orthopaedic
surgery, but at present, its use is neither universal nor
perfect. The limitations of AI are existing. First, the use
of AI is limited by the high capital cost, the time
needed for its use (both in preparation and intra-
operatively), the variable reliability of AI technologies,
and the absence of long-term follow-up studies.
Therefore, the cost and time of the AI technique needs
to be decreased, and more long-term studies are
required. Second, there are ethical considerations
regarding the use of ML in orthopaedic surgery.

22. • Working with bulk datasets increases the risks of breaching patient
confidentiality and consent unless safeguards are in place, especially
where conflicts exist between patient and commercial interests.
• Furthermore, in cases of misdiagnosis or maloperation, it is unclear
whether the doctor or the robot should be held responsible. Thus, it is
important that ML is meticulously studied, managed, and appropriately
validated.
• Third, to date, surgical robots and the AI technique can only be used to
perform relatively simple procedures, and possess little autonomy and
decision-making authority in treatment; these limitations have caused
some people to question the usefulness of AI.
• However, scientists and engineers are making substantial advancements in
AI-assisted procedures from non-autonomic robot assistance to task
autonomy or conditional autonomy and, eventually, full automation.

23. • Robotic joint arthroplasty has been shown to
be associated with increased success rates,
shorter preoperative plan and operation
duration, more accurate alignment, correct
positioning of components, shorter hospital
stays, less bleeding, lower complication rates,
and improved patient satisfaction than
conventional methods

24. Comparative Study
Comput Aided Surg
2012;17(2):86-95. doi: 10.3109/10929088.2012.654408
Comparison of robot-assisted and conventional total knee
arthroplasty: a controlled cadaver study using multi-parameter
quantitative three-dimensional CT assessment of alignment
Conclusion: Robot-assisted total knee arthroplasty showed excellent
precision in the sagittal and coronal planes of the 3D CT scan. In
particular, the robot-assisted technique showed better accuracy in
femoral rotational alignment compared to the conventional surgery,
despite the fact that the surgeons who performed the operations were
more experienced and familiar with the conventional method than
with robot-assisted surgery. It can thus be concluded that robot-
assisted total knee arthroplasty is superior to conventional total knee
arthroplasty.
• Young-Wan Moon 1 , Chul-Won Ha, Kwan-Hong Do, Chang-Young Kim, Jeong-Hoon Han, Sang-Eun Na, Choong-Hee
Lee, Jae-Gyoon Kim, Youn-Soo Park
• Affiliations Expand
• PMID: 22348661 DOI: 10.3109/10929088.2012.654408

25. • Robot-assisted total knee arthroplasty is
associated with a learning curve for surgical
time but not for component alignment, limb
alignment and gap balancing
• Hannes Vermue, Thomas Luyckx, Philip Winnock de Grave, Alexander Ryckaert, Anne-Sophie Cools, Nicolas Himpe & Jan
Victor
• Knee Surgery, Sport RA TKA is associated with a learning
curve for surgical time, which might be longer than reported
in current literature and dependent on the profile of the
surgeon. There is no learning curve for component
alignment, limb alignment and gap balancings
Traumatology, Arthroscopy (2020)Cite this article

26. • Computer and robotic – assisted total knee
arthroplasty: a review of outcomes
• Jobe Shatrov & David Parker
• Journal of Experimental Orthopaedics volume
• 7, Article numbe
• Conclusion
• Results for CAS-TKA show improvement in alignment, and early clinical outcomes have revealed
promising results, with longer-term data and medium-term survival analysis recently emerging showing
small benefits over conventional TKA. RTKA represents another phase of development. Early results
show similar trends to that of CAS TKA with longer-term data still to come

27. Efficacy and reliability of active robotic-assisted
total knee arthroplasty compared with
conventional total knee arthroplasty: a
systematic review and meta-analysis
Yi Ren1, Shiliang Ca-http://dx.doi.org/10.1136/postgradmedj-2018-136190
The current research demonstrates that active robotic-assisted TKA surgeries are
more capable of improving mechanical alignment and prosthesis implantation when
compared with conventional surgery. Further studies are required to investigate the
potential benefits and long-term clinical outcomes of active robotic-assisted TKA.

28. • Comparison of 1-year outcomes between
MAKO versus NAVIO robot-assisted medial
UKA: nonrandomized, prospective,
comparative study
• Chumroonkiet Leelasestaporn, Tomorn
Tarnpichprasert, Alisara Arirachakaran &
Jatupon Kongtharvonskul
Knee Surgery & Related Research
volume32, Article number: 13 (2020) Cite this article
Conclusions
This study demonstrated that two robotic
systems showed no difference in clinical
outcomes at 1 year and radiologic alignment of
implants, whereas operative time and
intraoperative blood loss were found to be less
in MAKO robot-assisted UKA.

29. • Original research| Volume 6,
ISSUE 4, P1001-1008.e3,
December 01, 2020
• Robotic Total Knee
Arthroplasty vs
Conventional Total
Knee Arthroplasty:
A Nationwide
Database Study
• Sione A. Ofa, BS
Conclusions
In the present study, the use of robotics for
TKA found lower revision rates, lower
incidences of manipulation under anaesthesia,
decreased occurrence of systemic
complications, and lower opiate consumption
for postoperative pain management. Future
studies should look to further examine the
long-term outcomes for patients undergoing
robot-assisted TKA

30. • Increased precision
of coronal plane
outcomes in robotic-
assisted total knee
arthroplasty: A
systematic review
and meta-analysis
• Ashim Mannan 1 , James
Vun 2 , Christopher Lodge 3
, Alistair Eyre-Brook 4 ,
Simon Jones 5
• PMID: 29439922 DOI:
10.1016/j.surge.2017.12.003
This systematic review and meta-analysis
demonstrates clear evidence of increased
accuracy of alignment in robotic-assisted knee
arthroplasty with specific regard to reconstituting
a neutral mechanical axis and minimising number
of outliers in the coronal plane. Further studies
and long term data is required in order to
conclude on survivorship and functional
outcomes.

31. Knee Arthroplasty
Published: 14 June 2020
• Robotic-assisted
total knee
arthroplasty is
comparable to
conventional
total knee
arthroplasty: a
meta-analysis
and systematic
review
• James Randolph
Onggo, Jason Derry
Onggo, Richard De
Steiger & Raphael Hau
Conclusion
Both rTKA and cTKA are reliable and safe
to perform. However, rTKA is capable of
achieving superior alignment in several
axes, lower mean blood loss and this may
lead to marginally better clinical
outcomes than cTKA.

32. So Balance the
GAP--