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Two studies using UK registry data found no significant difference in five-year implant survival between robotic and conventional hip and knee replacements. The findings bear on plans to expand NHS use of surgical robots, which add substantial equipment and per-procedure costs; the research did not assess every possible measure of recovery or patient experience.
Two studies of more than 2.5 million hip and knee replacements across the UK found no significant difference in five-year implant survival between robotic and conventional surgery, challenging the case for paying more to use surgical robots. The analyses, published in The BMJ and based on national registry data, found similar revision outcomes across the procedure types studied.
Researchers led by Hasan R. Mohammad of Queen Mary University of London compared robotic operations with conventional procedures using the National Joint Registry. The data covered England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey, but not Scotland, and included surgeries performed from 2018 to 2024. The team used clinical and demographic information, including surgeon procedure volume, to match patients receiving robotic surgery with similar patients who had conventional operations.
In the matched groups, five-year implant survival was 98.8% for both robotic and conventional total hip replacements. For total knee replacements, survival was 98.6% with robotics and 98.5% with conventional surgery. For unicompartmental knee replacements, it was 96.4% with robotics and 97.8% with conventional surgery. The researchers reported no significant overall survival differences; comparisons in the full, unmatched populations were also broadly similar.
The analysis included 656,080 conventional and 10,203 robotic total hip replacements; 585,242 conventional and 17,431 robotic total knee replacements; and 89,792 conventional and 4,680 robotic unicompartmental knee replacements. The investigators also found no significant difference in all-cause mortality among hip replacement patients. Some differences in hip complications appeared in unmatched data but were no longer statistically significant after matching, while knee complication and revision-reason comparisons showed no significant differences.
Costs Put NHS Robot Plans Under Scrutiny
The findings matter because robotic systems add costs to operations that are already common. The reports estimated that a robot costs about £1 million to purchase, with an additional £1,000 to £2,500 per procedure. If the technology does not reduce revisions, health services face a question about whether possible benefits in accuracy or recovery justify the added expense.
The issue has direct relevance to the NHS. A UK government 10-year plan published in July said the health service intended to increase sevenfold the proportion of hip and knee replacements performed with robotic assistance. It said adoption would expand in line with National Institute for Health and Care Excellence (NICE) guidance, which considers clinical evidence and cost-effectiveness. The new results could inform that assessment, but do not by themselves settle how the NHS should use the technology.
Revision surgery is a consequential outcome for patients and health systems, but it is not the only measure of success. A lack of difference in five-year implant survival does not establish that the procedures produce identical pain, stiffness, function, or longer-term results. The study therefore gives decision-makers evidence about revisions and costs, while leaving other potential patient benefits open for further evaluation.
total hip replacement surgical robot
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How the Registry Comparison Was Made
Robotic assistance has been promoted partly as a way to improve implant positioning. The rationale is that more accurate placement might reduce malalignment or loosening and, in turn, prevent some early revisions. The BMJ studies tested whether national registry outcomes showed that expected revision advantage in routine practice.
Rather than randomly assigning patients, the researchers conducted an observational analysis and matched nearly all robotic cases with four conventional-surgery patients using recorded characteristics. This approach helps make the groups more comparable, but cannot account for every difference that may affect treatment choice or outcomes. Most operations took place in the NHS, so results may not transfer directly to other countries or health systems.
“Given the observational design of the study … we cannot rule out the possibility of unmeasured and residual confounding.”
— The researchers, led by Hasan R. Mohammad
Recovery Benefits Remain Unmeasured
The studies do not establish whether robotic surgery changes outcomes such as pain, stiffness, mobility or patient-reported function, and the registry analysis cannot rule out residual confounding. The results also concern five-year implant survival; they do not answer whether outcomes diverge over a longer period.
Some potentially favorable hip findings—including fewer revisions for dislocation and fewer acetabular or femoral fractures in unmatched comparisons—became statistically insignificant after matching. The reports therefore do not confirm that those differences were caused by robotic assistance. Nor can findings from NHS-heavy UK data automatically be applied to health systems with different patients, surgeons, costs or care pathways.
NICE Guidance Will Shape NHS Use
The next policy question is how NICE evaluates the evidence alongside the expense of purchasing and operating robotic systems. The government plan ties expanded adoption to NICE guidelines, but the supplied reports do not specify when the agency will issue or revise recommendations in response to these studies.
Further evidence could clarify outcomes beyond revision rates, including patient-reported recovery, complications, longer-term implant survival and whether results vary by procedure or patient group. Until those questions are answered, the studies support a cautious conclusion: the registry data show no significant five-year revision-related advantage, while the broader value of robotic assistance remains unresolved.
Key Questions
Did robotic surgery improve five-year survival of hip or knee implants?
The studies found no significant overall difference in five-year implant survival between robotic and conventional procedures. Matched-group rates were 98.8% for both types of total hip replacement, 98.6% versus 98.5% for total knee replacement, and 96.4% versus 97.8% for unicompartmental knee replacement.
How many operations were included?
The researchers analyzed more than 2.5 million procedures recorded from 2018 to 2024 in England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey. Scotland was not included.
Does this mean robotic surgery has no benefits?
No. The studies focused on registry outcomes, particularly revision and implant survival, and did not establish whether robotics affects pain, stiffness or function. The researchers discussed possible benefits from more accurate positioning, but those were not shown to produce a significant overall revision advantage in these analyses.
Why could the findings affect NHS policy?
The UK government has said the NHS plans to increase robotic hip and knee replacements, with adoption guided by NICE. The studies’ finding of similar five-year survival is relevant because robotic equipment was estimated to cost about £1 million per system, plus £1,000 to £2,500 per operation.
What are the main limitations?
The research was observational, so unmeasured differences between patients or treatment choices may have affected results. It also did not resolve outcomes beyond five-year survival or establish whether findings apply to health systems outside the UK.
Source: rss
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