Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis

BackgroundSystematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.MethodsWe searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.ResultsBased on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.ConclusionsDespite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.

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“…Also, we contacted experts in the field resulting in one more article eligible for inclusion. As a result, we included 42 SRs 12–14 36–74…”

Section: Resultsmentioning

confidence: 99%

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

Hasan

Zhang

Beal

et al. 2020

BMJ Surg Interv Health Technologies

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“…Total hip arthroplasty (THA) is an effective surgery alternative for patients with hip osteoarthritis (OA) or femoral head necrosis [ 1 , 2 ]. Kurtz et al [ 3 ] reported a 50% increase in the prevalence of THA from 1990 to 2002 and estimated nearly 572,000 THAs in 2030.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

et al. 2018

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BackgroundThis meta-analysis aimed to evaluate the postoperative clinical outcomes and safety of the direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA).MethodsWe searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2018 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCTs) were included. Outcomes included Harris hip score at 2 weeks, 6 weeks, 12 weeks, and 1 year; VAS at 24 h, 48 h, and 72 h; incision length, operation time, postoperative blood loss, length of hospital stay, and complications (intraoperative fracture, postoperative dislocation, heterotopic ossification (HO), and groin pain).ResultsNine RCTs totaling 754 THAs (DAA group = 377, PA group = 377) met the criteria to be included in this meta-analysis. The present meta-analysis indicated that, compared with PA group, DAA group was associated with an increase of the Harris hip score at the 2-week and 4-week time points. No significant difference was found between DAA and PA groups of the Harris hip scores at 12 weeks, 1 year length of hospital stay (p > 0.05). DAA group was associated with a reduction of the VAS at 24 h, 48 h, and 72 h with statistical significance (p < 0.05). What is more, DAA was associated with a reduction of the incision length and postoperative blood loss (p < 0.05). There was no significant difference between the operation time and complications (intraoperative fracture, postoperative dislocation, HO, and groin pain).ConclusionIn THA patients, compared with PA, DAA was associated with an early functional recovery and less pain scores. What is more, DAA was associated with shorter incision length and blood loss.

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“…Prolonged surgical times in roboticassisted cases have been attributed to learning curves or the placement of navigation pins and registration. 34 Notably, robotic assistance was used by only two, experienced posterior THA surgeons as the preferred method of instrumentation and it was not available for the majority of the study period (2013-2018). This effectively minimizes its influence on outcomes in this study.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty in Patients Younger than 35 Is Effective Regardless of Surgical Approach

Novikov

Luthringer

Cizmic

et al. 2020

The Journal of Hip Surgery

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Despite the increasing frequency of younger patients undergoing total hip arthroplasty (THA), very few, if any, studies report on postoperative outcomes that specifically compare the two most commonly used approaches in this age group. The purpose of our study is to assess whether surgical approach affects postoperative outcomes in THA patients younger than 35 years. A retrospective analysis of 115 patients younger than 35 years that underwent primary unilateral THA between January 2013 and April 2018 was conducted. Patients were divided into two cohorts: (1) patients that underwent THA utilizing the anterior approach and (2) patients that underwent THA utilizing the posterior approach. Subanalysis controlling for surgical case complexity and use of robotic assistance was performed. Radiographic analysis included measurement of perioperative leg length discrepancies. Of the total 115 patients, 37 were in the anterior THA cohort, and 78 were in the posterior THA cohort. All baseline patient characteristics were similar among both cohorts. Patients in the anterior THA cohort had shorter mean operative times (95 vs. 121 minutes; p < 0.01) and shorter mean hospital length of stay or LOS (1.9 vs. 2.8 days; p < 0.01). Leg length discrepancies, dislocation, revision, and all-cause postoperative complication rates were similar between both cohorts. When excluding complex cases and use of robotic assistance (anterior n = 36, posterior n = 39), there was no difference in operative time, LOS, or postoperative outcomes. Our study suggests that surgically complex patients were more likely to undergo posterior rather than anterior THA. When controlling for surgical complexity and use of robotic assistance, no difference between approach with respect to operative time, hospital LOS, dislocation, revision, and all-cause postoperative surgical complication rates in THA recipients under 35 years of age was found. The results suggest that the anterior and posterior approaches can be equally effective for the majority of young THA patients.

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Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis

Cited by 90 publications

References 39 publications

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

Total Hip Arthroplasty in Patients Younger than 35 Is Effective Regardless of Surgical Approach

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