In Episode 49 of The Joint Replacement Podcast, I sat down with Andrew Schneider, MD, an adult reconstruction surgeon and Assistant Professor of Orthopedic Surgery at Washington University in St. Louis. His clinical practice includes primary and revision hip and knee replacement, partial knee replacement, anterior hip replacement, and robotic-assisted joint replacement. (Washington University Orthopedics)
This conversation was a little different from many of our episodes. We spent the first half discussing something that receives far less attention than surgical technique: what it is actually like to build a career as a young academic arthroplasty surgeon. We then moved into several of the most debated topics in modern joint replacement, including robotic surgery, kinematic alignment, partial knee replacement, surgical approach for total hip replacement, artificial intelligence, and where technology may take our field over the next decade.
Why Choose Academic Arthroplasty?
For Schneider, the attraction of academics was never simply publishing papers. He described wanting a career in which he could “wear multiple hats”: operating, teaching, performing research, collaborating with industry, contributing to his institution, and taking care of complex patients.
That distinction is important for residents and fellows deciding between academic and private practice. Academic medicine does not necessarily mean spending your entire career in a laboratory or publishing dozens of papers each year. Schneider described something more practical: seeing a problem in the operating room, converting that problem into a research question, studying it, and ultimately allowing that work to shape your clinical niche.
One of the biggest advantages of starting at an established academic institution has been access to mentorship. Instead of formal education ending after fellowship, Schneider found himself surrounded by experienced surgeons he could turn to for difficult hips, knees, revisions, infections, and partial knee replacements. Weekly conferences allow surgeons to discuss challenging upcoming cases and learn from one another.
For a young surgeon, that type of environment can provide a valuable bridge between being a trainee and becoming an independent attending.
Learning to Teach When You Are Still Learning Yourself
One of my favorite parts of the conversation was Schneider’s description of teaching as a young attending.
Imagine being in your first year of practice performing a difficult case with a fellow who finished training only one year after you. You encounter a problem, the fellow suggests something they saw another surgeon do, and sometimes the correct response is simply: “That is a good idea.”
His point was that teaching early in your career requires humility.
It also forces a surgeon to understand an operation at a different level. Performing a procedure yourself is one skill. Being able to calmly communicate exactly what you want another surgeon to do while knowing when to intervene, when to take over, and when to give the operation back is another skill entirely.
Schneider also discussed something most experienced surgeons eventually appreciate: the operation is often not simply about making bone cuts. Exposure, retractor placement, protection of soft tissues, anticipating problems, and understanding the next several steps may be much more important than the few seconds during which a saw passes through a cutting block.
Building a Practice From the Ground Up
Starting an academic practice can also require patience.
When a young surgeon joins a department filled with established names, it can be difficult to immediately compete for volume. Schneider’s approach was to accept that his practice might grow gradually while using the opportunity to observe how successful senior surgeons operate both inside and outside the operating room.
He emphasized watching how experienced partners prepare, interact with patients, handle complications, and manage difficult cases. Rather than viewing established surgeons as competition, he viewed proximity to them as an opportunity to learn.
His experience has also been that a strong clinical reputation eventually drives referrals. Take care of patients well, be available for difficult cases, treat people respectfully, and volume can follow naturally.
Research, Industry Collaboration, and Finding a Niche
Another challenge for junior academic surgeons is deciding where to spend limited time.
Clinical volume, publications, teaching, committees, meetings, family, institutional responsibilities, and industry opportunities all compete for attention. Schneider cautioned against simply saying yes to everything. Instead, he has relied heavily on senior mentors to help determine which opportunities are likely to be meaningful over the long term.
The same principle applies to industry collaboration.
His advice to young surgeons was not to simply perform a large number of cases with one company’s implants and expect that to create a meaningful relationship. Instead, he suggested identifying a clinical interest, becoming knowledgeable about it, producing good research, and then bringing that expertise to industry.
In other words, develop expertise first and allow collaboration to follow.
He also emphasized the importance of conflicts of interest and maintaining scientific independence when evaluating new technologies.
Is Robotic Joint Replacement Actually Better?
We eventually shifted into one of the most controversial questions in arthroplasty today.
Patients frequently ask:
“Is robotic joint replacement better?”
Schneider’s answer was refreshingly nuanced.
If “better” means a routine primary hip or knee replacement will necessarily have a superior patient-reported outcome at one year simply because a robot was used, he said the answer is probably not.
But that does not mean the technology has no value.
Robotic systems can create patient-specific three-dimensional plans and allow surgeons to execute those plans with considerable accuracy and precision. Schneider views that precision not as the final outcome, but as a tool that may help us get to a better-defined target.
That distinction closely reflects the current debate in the literature. The RACER-Knee trial was specifically designed to determine whether improvements in surgical accuracy with robotic-assisted total knee replacement translate into clinically meaningful and cost-effective advantages over conventional instrumentation.[1] (BMJ Open)
The larger unanswered question may therefore not simply be whether robots are more accurate. They clearly can improve our ability to plan and execute. The question is:
What exactly should we be executing?
Robotics and Kinematic Alignment
That question leads directly into alignment philosophy.
Schneider performs most of his robotic total knee replacements using a kinematic alignment philosophy. His reasoning is straightforward: if an operation depends on reproducing millimeters of patient-specific bone resection, a technology designed to execute planned resections with high accuracy seems like a natural tool.
He described the tibial side as one area where robotics changed his practice substantially. When performing manual kinematic alignment, reproducing the desired tibial resection can be technically demanding. Robotic planning gives the surgeon information about the intended resection before making the cut and may reduce the need for iterative recuts.
Alignment remains an unsettled area of arthroplasty. A 2026 systematic review and meta-analysis of randomized trials found no significant overall difference in PROMs or reoperation rates between kinematic and mechanical alignment, although patients undergoing bilateral procedures were more likely to prefer the kinematically aligned knee. The authors emphasized the need for additional work identifying which patient populations may benefit most from different alignment strategies.[2] (PubMed)
That may ultimately be where robotics becomes most interesting: not simply reproducing the same operation more accurately, but enabling us to test and reliably execute different patient-specific surgical targets.
Are We Underusing Partial Knee Replacement?
Schneider estimates that approximately 15% of his knee arthroplasty practice consists of partial knee replacements, including both medial and lateral unicompartmental knee arthroplasty.
He highlighted the patient with isolated lateral compartment disease as one group that may be particularly underrecognized. A patient may have relatively preserved joint spaces on a standard standing AP radiograph but demonstrate dramatic lateral compartment collapse with the knee flexed. In the appropriately selected patient, he believes replacing the isolated diseased compartment rather than removing otherwise healthy cartilage may offer meaningful benefits.
He is also interested in both ends of the age spectrum: younger patients with isolated compartment disease, in whom preserving bone may make a future revision more manageable, and older patients who may benefit from a smaller operation with a faster recovery.
This is an area where Schneider has generated prospective data. In a 2026 study using remote monitoring, Schneider and colleagues compared recovery after robotic unicompartmental knee arthroplasty with robotic total knee arthroplasty and found improved early recovery during the first 90 postoperative days following UKA.[3] (PubMed)
His group is now planning prospective work examining whether the location and pattern of a patient’s preoperative pain can help predict outcomes after partial knee replacement.
Anterior vs Posterior Hip Replacement: Matching the Approach to the Patient
Schneider also performs both anterior and posterior total hip replacement.
Rather than viewing one approach as universally superior, he selects the approach based on the patient. He uses the direct anterior approach with fluoroscopy for many patients but is comfortable performing robotic-assisted posterior hip replacement when body habitus, medical comorbidities, or local anatomy make an anterior approach less attractive.
His philosophy is that hip replacement is an excellent operation through multiple approaches when the surgeon understands the risks and appropriately selects the technique for the individual patient.
Contemporary evidence similarly suggests that approach-specific advantages and disadvantages exist rather than a simple universally superior approach. A 2025 systematic review and meta-analysis compared direct anterior and posterior THA across multiple clinical outcomes, continuing a debate that increasingly centers on patient selection and surgeon experience rather than a single “best” approach.[4] (PubMed)
What Will Robotic Surgery Look Like in 2040?
We ended the episode by looking much further ahead.
Schneider made a prediction that I suspect may age very well: someday we may look back at today’s robotic systems—with pins drilled into bone, tracking arrays attached to those pins, and optical cameras requiring uninterrupted line of sight—and wonder why robotic surgery ever required so much hardware.
He envisions future systems determining the position of the extremity through technologies that may not require today’s trackers or arrays.
But his larger prediction involved artificial intelligence.
Imagine a 65-year-old patient walking into clinic. Instead of simply looking at an X-ray and selecting an alignment target based on a surgeon’s preferred philosophy, a future system might integrate the patient’s anatomy, BMI, comorbidities, activity goals, preoperative function, and outcomes from thousands of previously treated patients with similar characteristics.
It could then estimate how different surgical plans are associated with different probabilities of achieving a desired outcome.
That is fundamentally different from simply asking a robot to make a more precise cut.
It represents a closed-loop arthroplasty ecosystem in which planning, execution, and longitudinal patient outcomes continuously inform one another.
The concept is not entirely theoretical. AI and machine-learning systems are already being investigated for implant identification, preoperative planning, complication prediction, PROM prediction, risk stratification, and postoperative monitoring. At the same time, systematic reviews emphasize that many current models lack sufficient external validation and must be rigorously tested before widespread clinical adoption.[5,6] (PubMed)
The Bigger Picture
One theme connected nearly every part of this conversation: being early in your career does not mean you need to have everything figured out.
A young academic surgeon is simultaneously learning how to build a practice, become an effective teacher, conduct meaningful research, develop collaborations, manage increasingly difficult cases, and determine which areas of the field are worth pursuing.
Schneider’s approach is to identify meaningful clinical problems, surround yourself with good mentors and collaborators, remain willing to learn, and allow your niche to develop naturally.
The same philosophy applies to technology.
Robotics, kinematic alignment, partial knee replacement, remote monitoring, and artificial intelligence are all tools. The challenge for the next generation of arthroplasty surgeons will be determining how to use those tools to solve the right problems rather than simply adopting technology for technology’s sake.
Episode 49 of The Joint Replacement Podcast with Andrew Schneider, MD is available now on YouTube and Spotify.
References
- Griffin J, Davis ET, Parsons H, et al. Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial (RACER-Knee): a study protocol. BMJ Open. 2023;13:e068255. doi:10.1136/bmjopen-2022-068255. (BMJ Open)
- Blackman BW, Burow CA, Macciacchera MP, Hayes EW, Garceau SP. Kinematic and Mechanical Alignment Yield Similar Outcomes in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty. 2026. doi:10.1016/j.arth.2026.01.036. (PubMed)
- Schneider AM, Bendich I, Hannon CP, et al. Robotic Unicompartmental Knee Arthroplasty Demonstrates Improved Recovery During the First 90 Postoperative Days Compared With Robotic Total Knee Arthroplasty: A Prospective Remote Monitoring Study. J Arthroplasty. 2026. doi:10.1016/j.arth.2026.04.077. (PubMed)
- Ghandour M, Salomon O, Hammouchi M, et al. Direct anterior approach versus posterior approach in total hip arthroplasty: A systematic review and meta-analysis. J Orthop. 2025;65:233-250. doi:10.1016/j.jor.2025.06.007. (PubMed)
- Longo UG, et al. Artificial intelligence in total and unicompartmental knee arthroplasty. BMC Musculoskelet Disord. 2024. (PubMed)
- Current Concepts in Artificial Intelligence-Assisted Arthroplasty: A Review of the Perioperative Pathway. 2025. The review describes applications in planning, risk stratification, complication and PROM prediction while emphasizing the need for external validation and transparent evaluation before broad clinical implementation. (PubMed)