Robotic-assisted hip and knee replacement in NHS scotland: trends and efficiency implications (2020-2024)

Robotic-assisted hip and knee replacement has been increasingly adopted in orthopaedic practice, offering potential advantages in surgical precision and workflow consistency. However, its efficiency compared with conventional manual methods in real-world NHS practice remains debated. This retrospective observational study analysed routinely collected data from the Arthroplasty Rehabilitation in Scotland Endeavour (ARISE) programme, including patients undergoing unilateral primary hip or knee replacement between 2020 and 2024. Robotic-assisted status, type of surgery, and operative duration were examined. Uptake of robotic-assisted hip and knee replacement was assessed annually, and comparative analyses evaluated operative times between robotic-assisted and manual procedures. Robotic-assisted hip and knee replacements increased from 101 procedures in 2020 to 1164 in 2024, representing a tenfold rise. Despite this growth, robotic cases accounted for fewer than 10% of all hip and knee replacements, with uptake concentrated in a small number of centres. Median operative durations were similar between robotic-assisted and manual procedures for both hips and knees. However, robotic surgeries demonstrated narrower interquartile ranges and fewer outliers. Knee replacements showed consistently higher adoption than hip replacement across the study period. Robotic-assisted hip and knee replacement has expanded rapidly in NHS Scotland, though access remains uneven across hospitals. Operative efficiency is comparable to conventional methods, but improved consistency may offer service-level benefits such as more predictable theatre scheduling. Wider adoption will require strategic investment in infrastructure, training, and equitable resource distribution to maximise the potential benefits of robotic-assisted technology within the NHS.