As robotics play a larger role in total joint replacement surgeries, the procedures are proving to be more effective than ever. Andrews Sports Medicine & Orthopaedic Center in Birmingham has used the technology more than almost any other institution in the U.S.

"It depends on how you break down the numbers," said David Moore, MD, joint replacement specialist at Andrews. "My understanding is that from 2018 to the present, Ascension St. Vincent's is number one in the country, but as the technology has become more popular, we are falling off the pace a little bit, because there are more big institutions utilizing it now."

Under the urging of Moore, Andrews was the first practice to bring Stryker's Mako SmartRobotics technology to this area in 2017. They had lobbied Ascension St. Vincent's Birmingham to make the purchase, and ultimately were so convinced it would improve care that the practice purchased it themselves and leased it back to the hospital. The hospital now has three of the machines, which stay busy.

"We've completed well over 5,000 cases," said Jeffrey Davis, MD, orthopaedic surgeon and joint replacement specialist at Andrews. "We are pleased with the outcomes and it's an improvement in the way we perform the surgery. It allows for better planning, more accuracy and consistency, and x-ray outcomes are definitely better. It's like the difference between flying an airplane visually versus having instrumental input.

The technology allows the surgeon to be more precise, with less trial and error. "It helps the surgeon protect tissue that doesn't need cutting. It can put some boundaries around what you're doing, so the instruments stop and don't let you cut something unnecessarily," Moore said. "Part of getting a total knee to last as long as possible is getting the implants in the correct position. Previous technologies didn't allow us to us to be as precise as we would have liked, but with this we can make sure all the cuts we do are correct for each individual patient. I haven't done a surgery without Mako technology since we got it. It's that much better.

"However, we don't consider this surgery to be minimally invasive. The size of the scar depends on the size of the implants. It's not minimally invasive in terms of the incision, but there's less soft tissue damage and less in and out of the wound. In that sense, it's less invasive a surgery than it used to be, and less damaging."

"It's still a big surgery," Davis said. "It still takes four to six weeks to feel like yourself again and have the same energy level that you had before the surgery."

The surgeons urged other physicians to stop considering joint replacement as a last resort. "Some patients wait too long, until they are crippled," Moore said. "Implants are vastly improved and robots make it a better experience. The procedure has been undersold in the past."

"Joint replacement isn't 100 percent successful and it isn't a panacea," Davis said. "But it's as good a surgery as there is to improve quality of life. It's a viable option earlier in the process."

Despite the improvement technology has made to the procedure, Moore says the robot is still only a tool, and it's up to the surgeon to use it effectively. "Experience is still the most important thing when you are trying to decide who will do your surgery rather than whatever tools they use," he said." But there's no question the robot makes us more accurate. We are still very much in control, and we are at the patient's side. It's very hands on. It's truly robot-assisted surgery.

"Not everything that's new is better, but if it is better, we want to be industry leaders in that. We are thoughtfully cutting edge."