BOA comment on NICE EVA guidance on RAS in orthopaedics
The National Institute for Health and Care Excellence (NICE) has today (17th April 2025) published Early Value Assessment (EVA) guidance on the conditional use of six robot-assisted surgery (RAS) systems for orthopaedic procedures such as full and partial knee replacement procedures and hip replacements. The use of RAS in orthopaedics has seen a rapid expansion in the last five years, from approximately 300 procedures per annum in 2018/19 to over 4,000 cases 2024/25.
EVA guidance provides recommendations on promising health technologies that have the potential to address national unmet need, permitting earlier patient and system access in the NHS while further evidence is generated. By permitting conditional access to a limited number of systems, further evidence will be generated over the next three years to assess if the benefits of these technologies are realised in practice. NICE guidance will be reviewed to include this evidence and make a recommendation on the routine adoption of the technology across the NHS.
Systematic reviews and randomised controlled trials have shown the potential benefits for RAS in orthopaedic procedures include:
- Improved patient outcomes
- Reduced length of stay
- Improved Survivorship in registry data
- Less soft tissue damage
- Improved implant positioning
- Reduced dislocation rates
- Reduced rates of musculoskeletal injuries, fatigue and pain amongst surgeons
A major barrier to more widespread adoption of RAS for many organisations is the capital and revenue cost of establishing and running a RAS programme which have to be high volume and be capable of efficient turnaround times, with minimal downtime for the systems.
Scalability and equity of access to RAS are also an increasing challenge in providing training and mentorship at a pace that matches the procurement of RAS systems.
Mark Bowditch, BOA President said,
“We welcome this decision to support further evidence on novel innovative technologies such as robotic -assisted surgery. The UK is leading the world with designing and gathering the evidence on this in orthopaedics.
“We must innovate and adopt novel technologies for patients but it essential to do so in a safe and responsible manner with high quality data.
“There has been a widespread but an uncoordinated approach to the adoption of RAS across the UK healthcare sector, without an agreed national approach particularly in the NHS, leading to inequality of access.
“Although three years is possibly rather short in T&O outcomes terms, this EVA will hopefully give the opportunity to show if the 'improvements in precision’ correlate with potential improved patient outcomes and health economic benefits.
“The training requirements for the use of RAS are significant and is another instance where most consultant training in the use of novel technology has been delivered by industry providers. If we are to show the benefits and commit to equality of access in the longer term, then we must also commit to improvements in the estates and training to deliver these.
“Nevertheless, we are delighted at this step towards encouraging data driven innovation and working with our industry partners in potential improvements in patient care.”
The NICE robot-assisted surgery for orthopaedic procedures: early value assessment guidance can be viewed here.
Additional BOA resources can be found here.