A comparison of radiological and clinical outcomes between robotic‐assisted and conventional total hip arthroplasty: A meta‐analysis

Abstract

Background:The purpose of this study was to investigate whether robotic-assisted total hip arthroplasty (RATHA) is superior to conventional total hip arthroplasty (CTHA) in terms of radiological and clinical outcomes. Methods: Three databases (PubMed, Cochrane Library, and Embase) were searched for articles published before 11 May 2021. The comparison outcomes of interest included radiological and clinical outcomes.Results: Eighteen studies involving 2845 hips that compared the radiological and clinical outcomes of RATHA and CTHA were included in this study. There was no significant difference between RATHA and CTHA in cup anteversion or complications. However, RATHA showed better outcomes in terms of leg-length discrepancy, stem alignment, cup inclination, the Lewinnek safe zone, Callanan safe zone, total complications, and intraoperative complications. Robotic-assisted total hip arthroplasty was inferior to CTHA in terms of operative time and dislocations (all pvalues < 0.05). Conclusions:The radiological and clinical outcomes of RATHA were comparable and even better than those of CTHA, except for operative time and dislocation outcomes. K E Y W O R D Sconventional, meta-analysis, radiological and clinical outcomes, robotic-assisted, total hip arthroplasty | INTRODUCTIONDue to the ageing population and increasing life expectancy, an increasing number of elderly people suffer from hip osteoarthritis and other degenerative diseases. 1 Total hip arthroplasty (THA) is a safe and effective operation for end-stage hip diseases. 2 It is estimated that more than five hundred thousand people in the United States will undergo THA every year by 2030. 3 Therefore, it is critical to reduce the occurrence of complications and revision and improve long-term implant survival in THA.Due to advancements in surgical technology, improvements in prosthesis design, and optimised perioperative patient management, quality of life and prostheses survival in patients undergoing conventional total hip arthroplasty (CTHA) have greatly improved. [4][5][6] However, the incidence of complications and revisions is still not well controlled. 7 Since the introduction of robotic-assisted total hip Yuxiang Wang and Ruoyu Wang have contributed equally to this work and share the first authorship.

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case–control study

“…This study showed a significantly lower Hb drop in the R-PL group compared with the DAA group as well as a higher Hb value at post-operative day 1. Despite the overall reduction of blood loss, which supports the reduced surgical invasiveness of the robotic technique, the transfusion rate was the same for the DAA and R-PL groups, indicating limited blood loss also in the DAA group [ 7 ]. Furthermore, the higher Hb drop and lower Hb level of post-operative day 1 of the DAA group can be justified by the lower, although not significant, peri-operative Hb level of this group.…”

Radiographic study of direct anterior approach hip arthroplasty: a 10–15 year follow-up of Chinese patients

“…Although the "absolute safety" of Lewinnek's safe zone has been questioned [19], a large amount of clinical practice has shown that it still serves as a standard for determining the position of acetabular implants after hip arthroplasty. In cases where there is no significant deformity of the joint before surgery, or there is no fusion in the spine [20], the Lewinnek safe zone remains the most commonly used evaluation system [21]. Previously, there has been significant controversy regarding whether the direct anterior approach can achieve a better acetabular position than other commonly used surgical approaches [22][23][24].…”

Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty—A Retrospective Multicenter Analysis

“…During implantation, no navigation tool or robotic device was used. Current literature mostly shows the benefit of these techniques in terms of achieving the planned position of the cup and restoring the biomechanics of the hip [ 37 , 38 , 39 ]. Concerning the stem, there is conflicting evidence on whether the planned position can be achieved more accurately with navigation tools or robots.…”

“…Compared to conventional implantation, there was no significant difference in the accuracy of the placement of the femoral component. Wang et al recently published their meta-analysis on radiological and clinical outcomes between robot-assisted and conventional total hip arthroplasty [ 38 ]. With the use of robots, the desired coronal alignment of the stem was achieved significantly better.…”