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Two studies using U.K. joint registry data found no significant difference in five-year implant survival between robotic and conventional hip or knee replacement. The findings come as the NHS plans to expand robotic surgery, which carries substantial equipment and per-procedure costs; the studies did not assess every measure of recovery or patient experience.
Two studies drawing on more than 2.5 million hip and knee replacements in U.K. registry data found no significant difference in five-year implant survival between robotic and conventional surgery. The findings challenge the case for expanding a higher-cost approach as the National Health Service plans to increase its use of surgical robots.
Researchers led by Hasan R. Mohammad of Queen Mary University of London compared robotic procedures with conventional operations using records from England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey. The data covered procedures performed from 2018 through 2024; Scotland was not included. The two reports were published in The BMJ.
The matched analysis found five-year implant survival of 98.8% for both robotic and conventional total hip replacements. For total knee replacements, survival was 98.6% after robotic surgery and 98.5% after conventional surgery. For unicompartmental knee replacements, it was 96.4% with robotics and 97.8% with conventional surgery. Researchers reported that results were broadly similar in comparisons using the full, unmatched populations.
The analysis included 656,080 conventional and 10,203 robotic total hip replacements, as well as conventional and robotic total and partial knee replacements. Researchers matched nearly all robotic-surgery patients with four conventional-surgery patients on clinical and demographic factors, including surgeon procedure volume. The study also found no significant difference in all-cause mortality among hip replacement patients.
The Cost of Expanding Surgical Robots
The findings bear on a planned change in NHS practice. A 10-year government plan published in July 2026 said the service would raise sevenfold the proportion of hip and knee replacements performed with robotic assistance. The plan said adoption would expand in line with guidance from the National Institute for Health and Care Excellence, or NICE, which evaluates medical technologies for clinical and cost effectiveness.
The researchers estimated that a robotic device costs about £1 million to purchase, with an additional £1,000 to £2,500 per procedure. Similar five-year revision outcomes make it harder to justify those costs on the basis of preventing implant failure alone. The studies do not settle the policy question: NICE and health services may weigh other outcomes, costs over time and operational factors when considering whether and where robotic systems are worthwhile.
What the Registry Comparison Measured
Robotic assistance has been promoted as a way to improve implant positioning. The rationale is that better alignment could reduce problems such as loosening that may lead to early revision surgery. The registry studies tested whether robotic operations were associated with fewer revisions over five years, using implant survival as the main reported outcome.
In the matched hip replacement groups, revisions for dislocation and fractures of the socket or thighbone were not significantly different. In an unmatched analysis, revisions for dislocation were less common after robotic hip replacement—0.11% versus 0.33%—but that difference was no longer significant after matching. The knee analyses found no significant differences in complications or specific reasons for revision between robotic and conventional procedures.
““Beginning next year, we will expand surgical robot adoption in line with NICE [National Institute for Health and Care Excellence] guidelines.””
— The U.K. government’s 10-year plan
Benefits Beyond Implant Survival
The studies focused on registry outcomes, especially revision, and do not show whether robotic surgery affects every aspect of recovery. The researchers said improved positioning could potentially affect pain, stiffness, function, joint wear or instability, but the reported data did not establish those benefits. Revision rates also do not capture all differences patients may experience.
Because the research was observational, unmeasured differences between patients or procedures could have affected the results even after matching. Most operations took place in the NHS, so the findings may not apply in the same way to health systems with different patients, wait times or surgical practices. The available results also do not establish whether outcomes vary across robotic systems, surgeons or hospitals.
NICE Guidance and NHS Adoption
The next policy question is how NICE will weigh the studies alongside other clinical outcomes and the costs of purchasing and using robotic systems. The government plan says NHS expansion will follow NICE guidance, but the source material does not specify when any review or decision based on these reports will be published.
Until further evidence or guidance clarifies the issue, the studies support a specific conclusion: five-year implant survival was similar in the compared groups. They do not establish that robotic surgery offers no benefit on any measure, or that the results will hold in every setting.
Key Questions
Did robotic surgery improve five-year implant survival?
The studies found no significant improvement for robotic hip or knee replacements compared with conventional surgery. Survival was 98.8% in both matched hip groups and similar in the total knee groups.
How many procedures were included?
The researchers analyzed registry data covering more than 2.5 million procedures performed from 2018 to 2024 in England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey. Scotland was excluded.
Did the studies find any differences?
An unmatched analysis found fewer revisions for dislocation after robotic hip replacement, but the difference was no longer significant in matched groups. Knee complication and revision-reason comparisons showed no significant differences.
Do the findings prove robotic surgery has no patient benefits?
No. The studies assessed registry outcomes including revision and implant survival. They do not settle whether robotics affects other outcomes, such as pain, stiffness or function, and their observational design cannot rule out residual confounding.
What is the NHS planning?
A government plan published in July 2026 said the NHS would raise sevenfold the proportion of hip and knee replacements performed with robotic assistance, with expansion tied to NICE guidance.
Source: rss
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