The NHS wants to go from 70,000 robot-assisted operations a year to 500,000 by 2035.¹
Six of the robotic systems in that plan are for joint replacement. Not one of them is fully approved by the UK’s own evaluation body.²
Nobody leading the announcement mentioned that. I will.
After 10,000+ hip and knee replacements, a Mayo Clinic fellowship and an engineering degree from Rose-Hulman, I am not a technophobe. I use technology in my OR. I help design the implants other surgeons use.
That is exactly why I’m asking the question no one on that stage asked: why are we scaling a technology for hips and knees when the outcomes aren’t better?
The Headline and the Evidence Are Telling Different Stories
To be fair, the plan is bold, and some of the wins are real.
Hysterectomy patients going home within 24 hours. Throat cancers removed without splitting the jaw. Bladder cancer patients discharged in five days instead of ten.¹
In soft tissue surgery, robotics has earned a serious seat at the table. I won’t pretend otherwise.
But look at who’s missing from the success stories.
Not one hip. Not one knee.
NICE, the UK body that evaluates whether health technology actually works, reviewed six orthopedic robotic systems. Mako, ROSA, VELYS, CORI and two others. It did not approve them. It conditionally recommended them, and only while companies gather evidence over the next three years.²
Look at what NICE says is still missing: patient-reported quality of life. Revision rates. Readmissions. Theatre time. Staffing and training costs.²
That isn’t fine print. That’s the whole case.
We are scaling first and proving it later.
In any other part of medicine, we’d call that backwards. In health system procurement, we call it a strategy.
Precision on the X-Ray Is Not Function in the Patient
Here is what the data actually shows so far.
A 2025 meta-analysis in the Annals of Medicine and Surgery pooled 21 randomized controlled trials and 2,692 patients comparing robotic and conventional knee replacement.³
The robots won on alignment. Fewer outliers, less deviation from the target axis. On the post-op X-ray, the work looks cleaner.
But on the measures patients actually live with, like WOMAC and Oxford Knee Scores, there was no meaningful difference. The authors concluded that robotic assistance improves precision but does not deliver superior function in the short to medium term.³
And each robotic case took about **20 minutes longer.**³
This is where the engineer in me gets angry. We’ve built a system that optimizes the variable that’s easiest to measure, not the one that matters. Alignment is a proxy. Pain, function, complications and revisions are the outcome.
When you optimize the proxy and call it progress, you’re not doing engineering. You’re doing marketing.
The safety signal deserves attention too. Australian national registry data on Mako-assisted partial knee replacement showed revision for infection at 2.91 times the rate of conventional surgery over the study period, and 5.57 times in the first three months.⁴
Here in the U.S., where surgeons have had access to these systems for years, robotic use sits at 16.1% of knees and 6.5% of hips per the American Joint Replacement Registry, and both numbers dipped from 2023 to 2024.⁵
The surgeons with the most hands-on experience aren’t racing to adopt it. That should tell a health system something before it signs the purchase order.
The Capacity Argument Doesn’t Survive the Math
The official pitch is about waiting lists: more procedures, faster recovery, shorter queues.
Run the numbers on a joint replacement list.
Twenty extra minutes per knee. On a four-knee day, that’s 80 minutes. That’s close to one fewer patient a day, not one more.
So what exactly is the benefit of more surgical capacity without better outcomes? And where does that capacity even come from, if each case takes longer?
More surgeries is not the goal. Better lives are the goal.
Scale average results and you don’t get progress. You get more average results. Faster. At a much higher price.
The UK’s orthopedic backlog isn’t a machine shortage. It’s a surgeon shortage. You can buy a robot in one budget cycle. You can’t buy the judgment of a surgeon who has done 5,000 knees.
That judgment is where the real value is. After 10,000+ procedures, the most important decision I make usually happens before the OR. Who needs surgery. Who doesn’t. Which approach fits this patient’s anatomy and this patient’s life.
No robot makes that call.
I’ll own something here. Early in my career, I bought into new technology because it was new. I believed the sales pitch before I read the data, and my patients didn’t do any better for it. That lesson cost me years to fully unlearn. It’s the reason I now demand the evidence before the rollout, not after. [FLAG: constructed accountability moment, replace with a real one from Dr. Meneghini]
At Indiana Orthopedic Institute, every technology decision goes through one filter: does it improve the outcome for the patient in front of us? Not the throughput. Not the brochure. The outcome. That’s how you build a practice that grows from two people to 100 employees and 16 surgeons in three years without compromising care.
The Evidence-Before-Scale Test
Before any health system, in the UK or here, buys “the future,” it should answer three questions.
1. What outcome actually improves?
Not alignment. Not throughput. Pain, function, complications, revisions. If the data isn’t there, the rollout shouldn’t be either.
2. Does the evidence match the specialty?
A win in cancer surgery doesn’t carry over to a knee replacement. Every field has to earn it with its own data. Soft tissue robotics doesn’t get to vouch for orthopedics.
3. Is the capacity problem really a robot problem?
We don’t lack machines. We lack trained surgeons. Fund fellowships and mentorship, and the capacity will follow.
If a technology can’t pass all three, it’s not an investment. It’s an expensive assumption paid for with public money.
What Comes Next
To health system leaders: the robot won’t fix your waiting list. Your surgeons will. Put the capital where the capacity actually is.
To surgeons: learn the technology, use it where it helps, and never let a capital budget make a clinical decision for you. The moment you do, you’re not the surgeon anymore. You’re the operator.
To patients: ask your surgeon one question. “What will this robot do for my outcome?” If the answer is about precision and not about how you’ll walk, sleep and live, keep asking.
Technology should raise the ceiling on care, not just the volume.
If a robot let us do twice as many surgeries with the same outcomes, would you call that progress? Or hype?
Notes
NHS England, national guidance on robot-assisted surgery, June 2025; reported by HT World, “NHS aims to carry out 500,000 robot-assisted operations a year by 2035.”
NICE, Robot-assisted surgery for orthopaedic procedures: early value assessment (HTE22 / HTG743). Six systems conditionally recommended pending a 3-year evidence generation plan.
Mostafa O, et al. “Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes.” Annals of Medicine and Surgery, 2025.
Australian Orthopaedic Association National Joint Replacement Registry, Mako robotic-assisted partial knee revision data.
American Joint Replacement Registry, 2025 Annual Report.
