Impact of Robotic Assistance on Total Hip Arthroplasty: Granular Insights into Surgical Time.

Background: Hospitals need efficiency and cost-effectiveness due to the shift to a value-based healthcare system. While robotic-assisted total hip arthroplasty (RA-THA) provides improved accuracy of component positioning, surgeons are concerned about increased surgical times. This study compared surgical time between RA-THA and manual THA (M-THA) through a granular analysis of individual procedural steps.

Methods: This prospective study was conducted at a single institution from February to March 2024. A consecutive series of 50 primary posterior approach THA cases were included, excluding patients who had prior hardware or previous ipsilateral surgery. The study comprised 25 RA-THAs and 25 M-THAs. There were six clinical fellows, supervised by five attending orthopaedic surgeons, who performed the surgeries, representing a typical clinical training scenario. Of the attending surgeons, three conducted RA-THAs using a computed tomography (CT)-based robotic platform, while two performed manual procedures. Key intraoperative steps individually recorded included pin placement, registration, and robotic reaming in the RA-THA group and acetabular reaming in the M-THA group. Multivariate regression models evaluated the impact of robotic assistance on surgical times.

Results: Total surgical times were similar for both groups (76 ± 10 versus 77 ± 13 minutes, P = 0.8). Robotic assistance did not significantly affect total surgical time (P = 0.5; 95% CI [confidence interval]: -8.7 to 19.7). The combined time for pin placement, registration, and reaming in RA-THA was comparable to acetabular reaming in M-THA (7 ± 1.1 versus 6.8 ± 1.8 minutes, P = 0.7). Acetabulum reaming in RA-THA was significantly shorter than in M-THA (2.3 ± 0.7 versus 6.8 ± 1.8 minutes, P < 0.001). Pin placement and registration times were 2.2 ±0.9 and 2.4 ± 0.7 minutes, respectively.

Discussion: The use of RA-THA does not increase surgical time compared to M-THA, indicating that the use of robotic systems can maintain OR efficiency. The additional time required for robotics seems to be offset by the reduced time needed for acetabular reaming. These findings support the broader adoption of robotic assistance in THA, offering potential benefits without compromising time.