Robotic-assisted total hip arthroplasty may improve implant positioning precision compared with conventional total hip arthroplasty, although patient-reported outcomes and complication rates were generally similar between approaches, according to a systematic review.
Researchers reviewed 9 studies published from 2015 to 2024 that compared robotic-assisted total hip arthroplasty with conventional total hip arthroplasty. The analysis included 933 patients from Asia, the US, the United Kingdom, and Italy, including 467 who underwent robotic-assisted procedures. Follow-up ranged from 3 months to more than 14 years.
The review included randomized trials, prospective studies, retrospective cohort studies, and a case-control study. Two studies represented longer-term analyses of the same patient population.
Primary outcomes included Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California-Los Angeles activity score assessments, which measure hip function, pain, and activity level. Across studies, researchers found no statistically significant differences between robotic-assisted and conventional procedures in patient-reported pain, hip function, or activity.
Conventional total hip arthroplasty generally required less operative time. In one prospective study, mean operative times were 104 minutes with robotic-assisted procedures vs 69 minutes with conventional procedures. A prospective randomized multicenter trial reported operative times of 110 minutes vs 87 minutes, respectively. A separate case-control study using the MAKO platform reported no statistically significant difference in operative time between approaches.
Blood loss findings were based on data from 2 studies and showed no statistically significant differences between approaches. Length-of-stay findings were also limited to 2 studies and were mixed. One study found no difference between approaches, whereas another reported shorter hospital stays among patients undergoing robotic-assisted surgery, with average stays of 2.5 days vs 4.3 days with conventional procedures.
Most complication outcomes, including revision surgery, infection, and dislocation, were similar between groups. However, several studies reported smaller limb length discrepancies with robotic-assisted procedures.
Radiographic outcomes suggested greater implant positioning precision with robotic-assisted surgery, although findings were not uniform across all measures. In one study, no patients undergoing robotic-assisted surgery had femoral stem alignment outliers compared with 6 patients undergoing conventional surgery. In another study, Lewinnek safe zone placement was achieved in approximately 91% of robotic-assisted cases vs 78% of conventional cases.
Researchers noted that improved radiographic precision did not translate into measurable differences in short- or medium-term clinical outcomes. The findings raise the possibility that radiographic improvements may represent surrogate endpoints whose clinical significance could require longer follow-up to determine.
The review also highlighted substantial heterogeneity across robotic platforms, including ROBODOC, MAKO, ROSA, LANCET, and other systems. The authors noted that differences in robotic technology, surgical workflow, and platform availability may limit generalizability across institutions and health systems.
The study further identified the learning curve associated with robotic-assisted surgery as a potential drawback, alongside increased equipment costs and longer operative times in many studies.
Limitations included the small number of high-quality randomized trials, heterogeneous study designs, inconsistent complication reporting, and relatively short follow-up periods. The researchers also noted that 7 of the 9 included studies reported conflicts of interest, many involving manufacturers of robotic surgical systems, which may affect interpretation of radiographic outcome findings.
“The comparison between RATHA and COTHA demonstrated that both techniques yielded similar clinical outcomes in terms of functional recovery and pain relief,” wrote lead study author Sarbhjit Singh Lakha Singh, of Melbourne Orthopedic and Trauma Institute, and colleagues. The researchers added that robotic-assisted procedures showed “a clear advantage in radiological precision.”
Disclosures: The researchers reported no conflicts of interest and no external funding for the systematic review. However, several included studies disclosed relationships with robotic system manufacturers.
Source: Oman Medical Journal