A decade of progress in orthopaedic telesurgery from concept to clinical feasibility: an evidence based review of robotics, latency science, digital ecosystems, and future remote surgical practice.

Telesurgery has transitioned from theoretical exploration to clinical demonstration over the past decade, driven by advances in robotic precision, real-time imaging, and next-generation communication networks. Orthopaedic surgery, traditionally challenging for remote intervention due to reliance on tactile feedback and millimetre-level accuracy, has increasingly adopted enabling technologies including 5G networks, navigation-guided robotics, extended reality, and artificial intelligence. This review synthesises evidence from twenty three key studies published between 2015 and 2025, comprising systematic reviews, engineering latency experiments, bibliometric analyses, telemedicine evaluations, and early telesurgical demonstrations. Spine surgery emerges as the most mature subspecialty for remote robotic operation, with clinical reports demonstrating 5G-enabled remote pedicle screw placement. Trauma surgery appears to be in a transitional phase, supported by remote pelvic screw navigation and experimental fracture-reduction robotics. Arthroplasty robotics, while not yet applied remotely, provide a critical technological foundation. Despite encouraging trends, substantial limitations remain, including latency sensitivity, limited haptic fidelity, regulatory barriers, and lack of large-scale clinical telesurgery trials. These challenges point toward future priorities involving hybrid autonomy, network redundancy, advanced haptics, and AI-driven predictive control. The convergence of robotics, digital ecosystems, and high-speed communication networks suggests that orthopaedic telesurgery may become a viable and transformative clinical reality in the coming decade.