Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA.

Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture.

The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772-1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)].

Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.

Total Hip Arthroplasty (THA) is the gold standard for treating end-stage hip osteoarthritis. Robotic-assisted systems, particularly the MAKO system, have been introduced to enhance reproducibility and safety. However, meta-analyses comparing MAKO-assisted THAs (MAKO-THA) to conventional methods are lacking, and previous reviews often aggregate various indications, introducing heterogeneity.

A random-effects meta-analysis was conducted on comparative studies between MAKO robotic-arm-assisted and conventional THAs in patients undergoing THA for solely hip osteoarthritis. Clinical outcomes (Harris Hip Scores [HHS], Forgotten Joint Scores [FJS], and Oxford Hip Scores [OHS]), radiographic parameters (implant positioning accuracy), leg-length-discrepancy, surgical duration, and complications were evaluated.

20 comparative studies were included. MAKO-assisted THAs resulted in higher postoperative HHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1), FJS (MAKO-THA: 84.7, 95%CI: 79.9-89.6; C-THA: 74.9, 95%CI: 64.0-95.7), and OHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1). FJS and OHS improvements were significantly greater compared to conventional THA (HHS WMD 2.2 [95%CI: -0.3-4.7, p = 0.09; FJS WMD: 8.7 [95%CI: 2.7-14.8], p = 0.005; OHS WMD: 1.5 [95% CI: 0.1-2.8], p = 0.03). MAKO-THA resulted in 94.7% and 90.3% of implants positioned within Lewinnek-and-Callanan zones, respectively, compared to 65.8% and 57.1% in conventional THA. MAKO-THA had longer mean surgical durations and lower postoperative leg-length discrepancy, but not significantly (Surgical Duration WMD: 3.5 [95%CI: -2.5-9.5], p = 0.3; Leg Length Discrepancy WMD: -0.2 [95%CI: -0.7-0.4], p = 0.6). Complication rates were low and non-significant (MAKO-THA: 3.0% [95%CI: 1.2-7.4]; C-THA: 3.5% [95% CI: 1.2-10.1), p = 0.3).

MAKO robotic-arm-assisted THA significantly improves Forgotten Joint Scores, Oxford Hip Scores and reproducibility in implant positioning without compromising on surgical duration and complication rates.

CRD42024542794.

Robotic-assisted total hip arthroplasty (rTHA) is associated with improved component positioning compared to manual THA (mTHA). However, its impact on achieving the minimal clinically important difference (MCID) in patient-reported outcomes remains unclear. This study compared rates of MCID for improvement (MCID-I), MCID for worsening (MCID-W), and complication rates between rTHA and mTHA.

We performed a retrospective analysis of 341 rTHAs, matched 1:3 by propensity score to 1,023 mTHAs based on age, sex, body mass index, and Charlson Comorbidity Index. All THAs were performed between 2016 and 2022. Patient-reported outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Global Mental, PROMIS Physical Function Short Form 10a (PF-10a), and the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS). We compared the rates of MCID-I and MCID-W between rTHA and mTHA at one year postoperatively, as well as 90-day complication rates and 2-year revision-free survival.

For HOOS-PS, MCID-I rates were similar between mTHA and rTHA (85.3 versus 80.3%; P = 0.063), as were MCID-W rates (5.2 versus 7.6%; P = 0.16). Rates of MCID-I and MCID-W for PROMIS Global Physical, PROMIS Global Mental, and PROMIS PF-10a were also comparable between the groups (all P > 0.05). Additionally, no significant differences were found in 90-day readmission rates (mTHA: 8.3 versus rTHA: 8.5%; P = 0.67) or 2-year revision-free survival (98.5% for both groups; P = 0.99).

Robotic-assisted THA and manual THA have similar rates of clinically important improvements, complications, and revision-free survival. Both approaches demonstrate excellent outcomes at one year. Further research should investigate long-term differences between robotic-assisted and manual THA.

Despite the growing use of computer-navigated and robotic-assisted total hip arthroplasty (THA), uncertainty remains regarding their outcomes compared to manual THA. Therefore, we implemented the concept of reverse fragility index (RFI) to assess the statistical robustness of available randomized controlled trials (RCTs) designed to study comparative revision rates between manual and technology-assisted THA.

The RCTs reporting revision rates for manual and robotic-assisted/computer-navigated THA were included in our systematic review. Our search included all RCTs published until February 2, 2025. There were nine RCTs with 894 patients analyzed. The RFI, defined as the minimum number of event reversals necessary to change a nonsignificant result to statistically significant, was calculated for each study using a threshold of P < 0.05. The reverse fragility quotient (RFQ), which adjusts the RFI relative to the study sample, was additionally calculated.

The median RFI was five (interquartile range [IQR], 4 to 5) for both computer-navigated and robotic-assisted THA subgroups, meaning that a median of five events would be needed to change the results from nonsignificant to significant. The median RFQ was 0.045 (IQR, 0.036 to 0.083), indicating that an event reversal in 4.5% of patients would be sufficient to make the results significant. The median number of patients lost to follow-up was six (IQR, 0 to 41). Of the nine studies, seven (78%) had a loss to follow-up greater than or equal to its RFI.

We observed significant statistical fragility in all included RCTs that compared revision rates of manual versus technology-assisted THA. We recommend routine reporting of RFI and RFQ metrics in future RCTs with nonsignificant findings, as well as careful interpretation of P-values.

II.

Prior lumbar spine surgery (LSS) can limit spine mobility, potentially increasing hip motion requirements. This study aimed to assess the influence of LSS on primary total hip arthroplasty (THA).

Retrospective analysis was conducted on patients who underwent THA with prior LSS. Included patients had completed patient-reported outcomes (PROs) and visual analog scale for pain questionnaires or had a documented revision surgery with a minimum 2-year follow-up. Patients were propensity matched to a benchmark control group of patients who did not have previous spine pathology in a 1:3 ratio, controlling for age at surgery, surgical approach, use of advanced technology, sex, and body mass index. The analysis included comparisons of hip arthroplasty thresholds and complications. Subanalyses based on the type of lumbar surgery and type of approach were also conducted.

There were 244 hips included in the study. The LSS group reported comparatively lower postoperative PRO scores. However, the LSS group experienced a similar magnitude of improvement. The LSS group met patient acceptable symptom state threshold for Forgotten Joint Score at a significantly lower rate. The LSS had a higher frequency of complications leading to revision THA with a relative risk of 24 and a relative risk of 20.8 for revision THA due to instability. Comparing patients by type of LSS, PROs, the percentage of patients reaching hip arthroplasty thresholds, and the revision THA rates were similar. There was no difference in complications considering the type of approach.

Patients who had prior LSS who underwent primary THA demonstrated equivalent improvements in PROs, but achieved lower overall postoperative scores and met hip arthroplasty thresholds at lower rates. Furthermore, patients undergoing primary THA with prior LSS had a higher risk of complications leading to revision surgery, including a 24-fold relative risk for complications leading to revision and a 20.8-fold relative risk of revision due to instability.

Optimizing leg length discrepancy (LLD) and restoring global and femoral offset (GO, FO) are integral to improving the stability and longevity of total hip arthroplasty (THA). A novel robotic-assisted THA (RA-THA) platform has been developed to utilize pre-operative templating and intraoperative fluoroscopic imaging to guide the restoration of native biomechanics. We sought to evaluate the effectiveness of this novel, pin-less, fluoroscopy-based RA-THA system to restore templated LLD and offset parameters.

We performed a retrospective analysis on a consecutive series of 98 patients who underwent fluoroscopy-based RA-THA at our institution. The primary outcomes were the differences between preoperatively templated LLD, GO, and FO parameters with intraoperatively achieved parameters measured by the robotic system and with postoperatively achieved parameters measured from postoperative radiographs.

The mean difference between achieved and preoperatively templated values of LLD (-1.5 ± 5.5 mm), GO (-0.1 ± 5.5 mm), and FO (-0.1 ± 5.4 mm) were all within - 1.5 mm of establishing equalized leg length and offset. The proportion of patients with a difference in achieved and templated values < 10 mm were 92% for LLD, 91% for GO, and 93% for FO. For 43 of the 98 (44%) patients in this study, the surgeon referenced intraoperative robotic data to adjust femoral components from the preoperative plan in order to optimize LLD and offset parameters.

The results of our present study demonstrated that fluoroscopy-based RA-THA is associated with high levels of accuracy in restoring key biomechanics of the hip. In a large number of patients, the surgeon used intraoperative robotic data to more closely achieve LLD and offset goals. This demonstrates the ability of this system to merge preoperative data with intraoperative, actionable data provided by the robotic software to restore leg length and global/femoral offset parameters. Words: 279/ 300.

Precise implant positioning during total hip arthroplasty (THA) is an important factor influencing dislocation rate and long-term implant survival. Although a special carbon fiber traction table for THA improves the accuracy of implant positioning, it is too expensive. We aimed to report the accuracy of cup positioning and complication rate in patients undergoing THA via the direct anterior approach using a conventional noncarbon fiber traction table, which is generally used for osteosynthesis of femoral fractures.

This retrospective study included 101 patients who received primary THA via the direct anterior approach using a conventional traction table with fluoroscopy between July 2022 and October 2024. Two observers evaluated radiological outcomes using postoperative anteroposterior X-rays. The intraclass correlation coefficients of cup positioning angles were calculated (inclination: 0.92, anteversion: 0.89 for intra-observer agreement; inclination: 0.91, anteversion: 0.85 for inter-observer agreement). Complications were defined as dislocation, periprosthetic fracture, ankle fracture, implant loosening, nerve injury, surgical site infection, deep vein thrombosis, and revision surgery for any reason.

Radiographic analysis showed an average cup inclination of 38.1° ± 4.1° (99.0% within Lewinnek's safe zone). The average cup anteversion was 12.0° ± 4.7° (97.0% within Lewinnek's safe zone). None of the patients experienced any complications.

The use of a conventional traction table to perform THA using fluoroscopy may not interfere with precise cup positioning. This technique, which does not require a special carbon fiber traction table for THA, could be a feasible alternative for performing THA at general hospitals.

In this study, we compared postoperative leg length discrepancy (LLD) after total hip arthroplasty using the anterolateral-supine approach (ALSA THA) with or without medial iliofemoral ligament (mILFL) preservation and examined the effect of the remaining mILFL on postoperative LLD.

This was a single-center, retrospective case control study. Unilateral primary THA with a preoperative LLD <15 mm, in which the contralateral side was intact, was included. After ALSA THA, we compared the absolute values of postoperative LLDs and examined the ratio of postoperative LLD >5 mm with and without mILFL preservation. Demographic data, clinical scores, and operative data were collected. Statistical significance was set at p < 0.05.

We included 341 hips (preservation group: 283 hips; resection group: 58 hips). The mean (range) absolute values of the postoperative LLDs were 2.3 (0-15.9) mm and 3.4 (0-14.8) mm, respectively. There was no significant difference between the two groups (p = 0.36). The proportion of postoperative LLD >5 mm differed significantly between the groups (4.4 % and 20.0 %, respectively; p < 0.01). Multiple logistic regression analysis showed that resection of the mILFL was the only significant factor that caused excessive leg lengthening (odds ratio, 5.28; 95 % confidence interval, 2.12-13.10, p < 0.01). Significant differences were reported in surgical time (81 (38-132) and 96 (54-157), respectively; p < 0.01) and intraoperative blood loss (297 (50-1170) and 388 (100-1150), respectively; p < 0.01). However, no significant differences in clinical scores, dislocation (including instability), or reoperation rates were observed between the two groups.

In patients with a preoperative LLD <15 mm, preserving the mILFL in ALSA THA avoids excessive leg lengthening and may lead to shorter LLD without any difficulties.

Despite the growing utilization of robotic-assisted total hip arthroplasty (rTHA), major debate remains regarding its comparative effectiveness in achieving optimal patient outcomes compared to manual total hip arthroplasty (mTHA). This study aimed to compare both the rate and time to achieve minimal clinically important difference (MCID) between rTHA and mTHA.

We conducted a retrospective analysis comparing 341 rTHAs with a 1:3 propensity score-matched cohort of 1,023 mTHAs performed from 2016 to 2022. Propensity scores were generated based on age, sex, body mass index, and Charlson comorbidity index. Patient-reported outcomes were evaluated using preoperative and postoperative scores of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function-10a (PF-10a), and Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS). The time to achieve MCID was assessed using survival curves with and without interval censoring, and statistical comparisons were performed using log-rank and weighted log-rank tests.

Manual total hip arthroplasty demonstrated a significantly higher rate of achieving MCID for PROMIS Global Physical (84.1 versus 79.8%, P = 0.003) and HOOS-PS (60.0 versus 44.9%, P < 0.001), while rates for PROMIS PF-10a were similar (58.6 versus 56.0%, P = 0.085). In the interval-censored analysis, rTHA achieved MCID for HOOS-PS significantly faster than mTHA (0.67 versus 1.0 months, P < 0.001). However, no significant differences were found for PROMIS Global Physical (0.24 versus 0.70 months, P = 0.18) and PROMIS PF-10a (1.60 versus 3.03 months, P = 0.73) when compared to mTHA.

We conducted a propensity score-matched analysis of rTHA and mTHA, accounting for baseline characteristics, but not factors such as case difficulty and anatomic complexity. We found that rTHA achieved MCID faster, while mTHA had a higher overall proportion of MCID achievement. Robotic-assisted surgery may expedite initial recovery, while manual techniques may lead to better long-term outcomes.

Total hip arthroplasty (THA) is a widely performed surgical procedure that has evolved significantly due to advancements in artificial intelligence (AI) and robotics. As demand for THA grows, reliable tools are essential to enhance diagnosis, preoperative planning, surgical precision, and postoperative rehabilitation. AI applications in orthopedic surgery offer innovative solutions, including automated hip osteoarthritis (OA) diagnosis, precise implant positioning, and personalized risk stratification, thereby improving patient outcomes. Deep learning models have transformed OA severity grading and implant identification by automating traditionally manual processes with high accuracy. Additionally, AI-powered systems optimize preoperative planning by predicting the hip joint center and identifying complications using multimodal data. Robotic-assisted THA enhances surgical precision with real-time feedback, reducing complications such as dislocations and leg length discrepancies while accelerating recovery. Despite these advancements, barriers such as cost, accessibility, and the steep learning curve for surgeons hinder widespread adoption. Postoperative rehabilitation benefits from technologies like virtual and augmented reality and telemedicine, which enhance patient engagement and adherence. However, limitations, particularly among elderly populations with lower adaptability to technology, underscore the need for user-friendly platforms. To ensure comprehensiveness, a structured literature search was conducted using PubMed, Scopus, and Web of Science. Keywords included "artificial intelligence", "machine learning", "robotics", and "total hip arthroplasty". Inclusion criteria emphasized peer-reviewed studies published in English within the last decade focusing on technological advancements and clinical outcomes. This review evaluates AI and robotics' role in THA, highlighting opportunities and challenges and emphasizing further research and real-world validation to integrate these technologies into clinical practice effectively.

The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes.

Data were retrospectively analyzed for patients who received hip resurfacing between 2010 and 2021. Eligible patients had postoperative radiographs and completed a minimum 2-year follow-up questionnaire for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Forgotten Joint Score (FJS), visual analog scale (VAS) score, satisfaction, and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Hips were propensity matched in a 1:1 ratio based on the use of navigation, age, and body mass index. The percentage of hips that met the minimal clinically important difference (MCID) for mHHS and VAS score was noted. Component placement analysis was conducted based on the safe zones defined by Lewinnek and Callanan and the Relative Acetabular Inclination Limit.

Seventy-six hips were matched, 38 per group. No differences were observed in patient-reported outcomes or the percentage of hips reaching MCID between the groups. The navigation group was 28.8 and 6.8 times more likely to be within the Callanan and Lewinnek safe zones, respectively. Based on the Relative Acetabular Inclination Limit, the navigation group was 3.1 and 6.4 times more likely to be within the 95% and 99% CI safe zones, respectively.

Comparable improvements in patient-reported outcomes were observed in the two groups during a minimum 2-year follow-up. Navigation-assisted surgery enhances the accuracy of acetabular component positioning, with a higher likelihood of cup placement within the safe zones. [Orthopedics. 2025;48(1):e1-e6.].

Accurate component placement plays a critical role in the outcome of total hip arthroplasty (THA). Robotic-assisted THA (R-THA) has emerged as an option to optimize this aspect compared to the conventional manual THA (C-THA). The aim of this meta-analysis was to analyze the studies comparing R-THA and C-THA. The hypothesis was that the use of robotic technology could improve component positioning, but this advantage may not translate into clinically relevant benefits.

The literature search was conducted on three databases (PubMed, Cochrane Library, and Web of Science) in January 2024. The screening process and analysis were conducted separately by two independent observers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were comparative studies, English language, no time limitation, and focusing on the comparison of R-THA and C-THA. Among the 1,883 articles retrieved, 38 studies (10,055 patients) were included. The meta-analysis covered radiological outcomes, clinical outcomes, perioperative parameters, complications, and revisions. The quality of each article was assessed using the "Downs and Black's checklist for measuring quality".

Robotic THA provided superior radiological results compared to C-THA in terms of acetabular cup placement within the Lewinnek safe zone (P < 0.01) and horizontal change of the rotation center (P = 0.03). No statistically significant difference was obtained in terms of clinical scores between the two approaches, including Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Forgotten Joint Score, and Merle d'Aubigné Hip Score. Robotic THA showed longer operative time (P < 0.01), but lower complication rates (P = 0.04). No difference was obtained in terms of intraoperative blood loss and revision rates.

The results of this meta-analysis suggest that R-THA can provide more accurate cup placement and better restoration of the native hip anatomy while reducing complication rates compared to C-THA. However, these benefits did not translate into clinical differences in terms of patient-reported outcomes between the two approaches, and R-THA required longer operative time. While the overall results suggest some benefits with the robotic technology, future studies should investigate if further technical improvements will translate into clinically relevant benefits for patients undergoing THA.

As the use of robotics in total hip arthroplasty (THA) continues to gain popularity, differences in clinical outcomes when compared to manual techniques have remained unclear. This study aimed to compare postoperative complications between patients undergoing robotic-assisted techniques and manual THA for primary osteoarthritis at 90 days, 1 year, and 2 years.

Using an all-payer national database, we identified 405,048 patients who underwent either robotic-assisted or manual THA for primary osteoarthritis. A propensity match was performed for age, sex, a comorbidity index, chronic kidney disease, obesity, and diabetes, resulting in 7652 patients in each cohort. We assessed postoperative outcomes, including surgical site infections, pulmonary emboli, venous thromboemboli, wound complications, dislocations, aseptic revisions, periprosthetic joint infections, and periprosthetic fractures. We completed bivariate analyses via chi-square tests to assess categorical variables. We utilized student's t-tests to compare continuous variables, including ages and comorbidities. Odds ratios (ORs) were calculated for complications using 95% confidence intervals (CIs).

The robotic-assisted cohort had lower rates of dislocation at 90 days (0.93 vs 1.41%, OR 0.65, 95% CI 0.48-0.88, P = .007), 1 year (1.32 vs 1.92%, OR 0.68, 95% CI 0.53-0.88, P = .004), and 2 years (1.66 vs 2.1%, OR 0.79, 95% CI 0.62-0.99, P = .049). Total surgical complications were significantly lower in the robotic-assisted cohort at 1 year (5.29 vs 6.16%, OR 0.85, 95% CI 0.74-0.98, P = .0205), but were similar at 90 days and 2 years. At 90 days, the rates of medical complications, including surgical site infections, pulmonary emboli, venous thromboemboli, and wound complications, were similar (all P > .05). The rates of periprosthetic joint infections, aseptic revision, periprosthetic fractures, and aseptic loosening were similar at all time points (all P > .05).

Patients who underwent robotic-assisted THA had lower rates of dislocation at 90 days, 1 year, and 2 years. This finding supports the use of robotic assistance in THA, though further research is needed to confirm and strengthen these findings.

Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.

The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique.

The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts.

Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.

A robotic arm-assisted and a computed tomography (CT)- based navigation system have been reported to improve the accuracy of component positioning in total hip arthroplasty (THA). However, no study has compared robotic arm-assisted THA (rTHA) to CT-based navigated THA (nTHA) concerning accuracy of cup placement and acetabular fractures using the direct anterior approach (DAA). This study aimed to compare the accuracy of cup placement and the presence of intraoperative acetabular fractures between rTHA and nTHA using DAA in the supine position.

We retrospectively investigated 209 hips of 188 patients who underwent rTHA or nTHA using DAA (rTHA using the Mako system: 85 hips of 79 patients; nTHA: 124 hips of 109 patients). After propensity score matching for age and sex, each group consisted of 73 hips. We evaluated clinical and radiographic outcomes, comparing postoperative cup orientation and position, measured using a three-dimensional templating software, to preoperative CT planning. Additionally, we investigated the prevalence of occult acetabular fracture.

Clinical outcomes were not significantly different between the groups at 1 year postoperatively. The mean absolute error of cup orientation was significantly smaller in the rTHA group than in nTHA (inclination: 1.4° ± 1.2° vs. 2.7° ± 2.2°, respectively; p = 0.0001, anteversion: 1.5° ± 1.3° vs. 2.2° ± 1.7°, respectively; p = 0.007). The cases within an absolute error of 5 degrees in both RI and RA were significantly higher in the rTHA (97.3%) than in nTHA group (82.2%) (p = 0.003). The absolute error of the cup position was not significantly different between the two groups. The prevalence of occult acetabular fracture did not differ significantly between the two groups (rTHA: n = 0 [0%] vs. nTHA: n = 1 [1.4%]).

Cup placement using DAA in the supine position in rTHA was more accurate with fewer outliers compared to nTHA. Therefore, rTHA performed via DAA in a supine position would be useful for accurate cup placement.

Robotic surgery, known for its minimally invasive techniques and computer-controlled robotic arms, has revolutionized modern medicine by providing improved dexterity, visualization, and tremor reduction compared to traditional methods. The integration of artificial intelligence (AI) into robotic surgery has further advanced surgical precision, efficiency, and accessibility. This paper examines the current landscape of AI-driven robotic surgical systems, detailing their benefits, limitations, and future prospects. Initially, AI applications in robotic surgery focused on automating tasks like suturing and tissue dissection to enhance consistency and reduce surgeon workload. Present AI-driven systems incorporate functionalities such as image recognition, motion control, and haptic feedback, allowing real-time analysis of surgical field images and optimizing instrument movements for surgeons. The advantages of AI integration include enhanced precision, reduced surgeon fatigue, and improved safety. However, challenges such as high development costs, reliance on data quality, and ethical concerns about autonomy and liability hinder widespread adoption. Regulatory hurdles and workflow integration also present obstacles. Future directions for AI integration in robotic surgery include enhancing autonomy, personalizing surgical approaches, and refining surgical training through AI-powered simulations and virtual reality. Overall, AI integration holds promise for advancing surgical care, with potential benefits including improved patient outcomes and increased access to specialized expertise. Addressing challenges and promoting responsible adoption are essential for realizing the full potential of AI-driven robotic surgery.

Implant waste during total hip arthroplasty (THA) represents a significant cost to the USA healthcare system. While studies have explored methods to improve THA cost-effectiveness, the literature comparing the proportions of implant waste by intraoperative technology used during THA is limited. The aims of this study were to: 1) examine whether the use of enabling technologies during THA results in a smaller proportion of wasted implants compared to navigation-guided and conventional manual THA; 2) determine the proportion of wasted implants by implant type; and 3) examine the effects of surgeon experience on rates of implant waste by technology used.

We identified 104,420 implants either implanted or wasted during 18,329 primary THAs performed on 16,724 patients between January 2018 and June 2022 at our institution. THAs were separated by technology used: robotic-assisted (n = 4,171), imageless navigation (n = 6,887), and manual (n = 7,721). The primary outcome of interest was the rate of implant waste during primary THA.

Robotic-assisted THA resulted in a lower proportion (1.5%) of implant waste compared to navigation-guided THA (2.0%) and manual THA (1.9%) (all p < 0.001). Both navigated and manual THA were more likely to waste acetabular shells (odds ratio (OR) 4.5 vs 3.1) and polyethylene liners (OR 2.2 vs 2.0) compared to robotic-assisted THA after adjusting for demographic and perioperative factors, such as surgeon experience (p < 0.001). While implant waste decreased with increasing experience for procedures performed manually (p < 0.001) or with navigation (p < 0.001), waste rates for robotic-assisted THA did not differ based on surgical experience.

Robotic-assisted THAs wasted a smaller proportion of acetabular shells and polyethylene liners than navigation-guided and manual THAs. Individual implant waste rates vary depending on the type of technology used intraoperatively. Future studies on implant waste during THA should examine reasons for non-implantation in order to better understand and develop methods for cost-saving.

Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients' characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.

Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.

To compare the effect of a new complete robot-assisted total hip arthroplasty (RA-THA) with that of the manual total hip arthroplasty (MTHA) and to verify the accuracy and safety of the former.

Overall, 148 patients were enroled from 3 March 2021 to 28 December 2021 in this study and classified into RA-THA ( n =74 patients) and MTHA ( n =74 patients) groups. The sex, age, operative side, BMI, diagnosis, other basic information, operative time, acetabular prosthesis anteversion and inclination, femoral prosthesis anteversion and angulation, femoral prosthesis filling rate, leg length discrepancy (LLD), Harris hip score, and visual analogue scale (VAS) score of the two groups were compared.

No significant differences were observed in the two groups regarding sex, age, operative side, BMI, diagnosis, Harris hip score, VAS score, acetabular inclination, acetabular prosthesis anteversion, femoral prosthesis anteversion, combined anteversion, and femoral prosthesis filling rate ( P >0.05). The operative time was significantly longer in the RA-THA group than in the MTHA group (106.71±25.22 min vs. 79.42±16.16 min; t=7.30, P <0.05). The femoral angulation (1.78°±0.64°) and LLD (2.87±1.55 mm) in the RA-THA group were significantly lesser than those in the MTHA group (2.22°±1.11° and 5.81±6.27 mm, respectively; t=-2.95 and t=-3.88, P <0.05).

The complete RA-THA has some advantages over the traditional procedure in restoring the lower limb length and controlling the femoral prosthesis angulation. Thus, this study verifies the accuracy and safety of the robot-assisted system.

The use of a robotic system for the placement of pedicle screws in spine surgeries is well documented in the literature. However, there is only a single report in the United States describing the use of a robotic system to place two screws in osseous fixation pathways (OFPs) commonly used in the treatment of pelvic and acetabular fractures in a simulated bone model. The purpose of this study was to demonstrate the use of a robotic system to place screws in multiple, clinically relevant OFPs in a cadaveric model and to quantitatively measure accuracy of screw placement relative to the preoperative plan.

A single cadaveric specimen was obtained for the purpose of this study. All surrounding soft tissues were left intact. Screws were placed in OFPs, namely iliosacral (IS), trans-sacral (TS), Lateral Compression-II (LC-II), antegrade anterior column (AC) and antegrade posterior column (PC) of the right hemipelvis using standard, fluoroscopically assisted percutaneous or mini-open technique. Following the placement of screws into the right hemipelvis using standard techniques, screws were planned and placed in the same OFPs of the contralateral hemipelvis using the commercially available ExcelsiusGPS® robotic system (Globus Medical Inc., Audubon, PA). After robotic-assisted screw placement, a post-procedure CT scan was obtained to evaluate actual screw placement against the pre-procedure plan. A custom-made image analysis program was devised to measure screw tip/tail offset and angular offset on axial and sagittal planes.

For different OFPs, the mean tip offset, tail offset and angular offsets were 1.6 ± 0.9 mm (Range 0.0-3.6 mm), 1.4 ± 0.4 mm (Range 0.3-2.5 mm) and 1.1 ± 0.4° (Range 0.5-2.1), respectively.

In this feasibility study, surgeons were able to place screws into the clinically relevant fracture pathways of the pelvis using ExcelsiusGPS® for robotic-assisted surgery. The measured accuracy was encouraging; however, further investigation is needed to demonstrate that robotic-assisted surgery can be used to successfully place the screws in the bony corridors of the pelvis to treat traumatic pelvic injuries.

The adoption of new technology should be supported by improvements in patient-reported outcomes (PROMs). The purpose of this study was to assess the one-year PROMs of patients who underwent total hip arthroplasty (THA) using a novel, fluoroscopy-based, robotic-assisted (RA-THA) system when compared to a manual, fluoroscopic-assisted technique (mTHA).

A review of 91 consecutive mTHA and 85 consecutive RA-THA via a direct anterior approach was conducted. All cases were performed by the same surgeon at the same institution, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Outcomes included one-year Veterans RAND-12 (VR-12) Physical/Mental, Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function/Joint Replacement, and University of California Los Angeles (UCLA) Activity scores, as well as the difference between pre-operative and one-year post-operative PROMs.

Patients in the RA-THA cohort had lower pre-operative HOOS-JR scores compared to patients in the mTHA cohort (37.0 vs. 43.1; p = 0.031). Cohorts experienced similar one-year post-operative VR-12, HOOS, and UCLA Activity scores. Patients in the RA-THA cohort experienced greater improvements across all pre- and post-operative HOOS scores compared to patients in the mTHA cohort: Pain (+ 54.7 vs. +42.1; p = 0.009), Physical Function (-41.6 vs. -28.7; p = 0.007), and Joint Replacement (+ 46.6 vs. +33.0; p = 0.002). These differences exceeded minimum clinically important difference (MCID).

Both manual and robotic cohorts experienced benefit from THA at one-year post-operative. Importantly, the use of a novel, fluoroscopy-based robotic assistance system for primary THA resulted in greater improvements in PROMs at one-year relative to manual technique.

Although a trend of an improved alignment with robotic total hip arthroplasty (THA) over conventional methods has surfaced from recent series, it is unknown whether these results translate into meaningful enhancements in postoperative outcomes. To address this lack in the literature, we compared the perioperative morbidity and mortality with robotic and conventional THA in a large national cohort of 367,894 patients. We hypothesized that no significant differences would exist in the outcomes between the two groups.

Records were extracted from 2016-2019 from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project which is the largest in-patient database in the United States. From 367,894 THAs, robotics were employed for 7,863 patients. The remaining 360,031 conventional THAs served as controls. The two groups were compared for demographics, admission, and hospital stay details including costs, and mortality and morbidity data including medical and surgical complications. Descriptive statistics were used for demographic data while analytical statistics including t-tests, chi-squared tests, Fischer exact test, and Pearson chi-squared tests were used for perioperative outcomes. Statistical significance was set at p<0.005.

Demographic distributions between robotic and conventional THA groups displayed similar age and sex characteristics. Shorter mean lengths of stay (1.87 days) were seen in robotic THA versus conventional THA (2.33 days) while higher costs were noted for the former (mean $68,686.71 vs $66,840.39) (p<0.005). Low overall mortality (0.03% robotic, 0.09% conventional) was seen in both groups (p>0.005). Higher comparative incidences of anemia, acute renal failure, and pneumonia were seen in conventional THA (p<0.005) while no significant differences were noted for other complications including myocardial infarction, pulmonary embolism, deep vein thrombosis, and cardiac arrest (p>0.005). Among others, lower dislocation rates, mechanical complications, periprosthetic joint infection, and periprosthetic fractures were seen with robotic THA (p<0.005). Wound complications and superficial infection rates did not differ between the two groups (p>0.005).

Evidence has emerged from our results to support more routine adaptation of the robotic option of performing a THA. These can be based on lower local, systemic, and mechanical complications as demonstrated by the present study. Further evaluation of these results in follow-up would help establish the foothold of robotic surgery in total hip replacement in the modern context.

Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA.

This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery.

There were no significant differences for any of the baseline characteristics including spinopelvic mobility. The absolute error for achieving the planned horizontal COR was median 1.4 mm (interquartile range (IQR) 0.87 to 3.42) in RO THA versus 4.3 mm (IQR 3 to 6.8; p < 0.001); vertical COR mean 0.91 mm (SD 0.73) in RO THA versus 2.3 mm (SD 1.3; p < 0.001); and combined offset median 2 mm (IQR 0.97 to 5.45) in RO THA versus 3.9 mm (IQR 2 to 7.9; p = 0.019). Improved accuracy was observed with RO THA in achieving the desired acetabular component positioning (root mean square error for anteversion and inclination was 2.6 and 1.3 vs 8.9 and 5.3, repectively) and leg length (mean 0.6 mm vs 1.4 mm; p < 0.001). Patient-reported outcome measures were comparable between the two groups at baseline and one year. Participants in the RO THA group needed fewer physiotherapy sessions postoperatively (median six (IQR 4.5 to 8) vs eight (IQR 6 to 11; p = 0.005).

This RCT suggested that robotic-arm assistance in THA was associated with improved accuracy in restoring the native COR, better preservation of the combined offset, leg length correction, and superior accuracy in achieving the desired acetabular component positioning. Further evaluation through long-term and registry data is necessary to assess whether these findings translate into improved implant survival and functional outcomes.

Postoperative length of stay (LOS) and discharge dispositions following arthroplasty can be used as surrogate measurements for improvements in patients' pathways and costs. With the increasing use of robotic technology in arthroplasty, it is important to assess its impact on LOS. The aim of this study was to identify factors associated with decreased LOS following robotic arm-assisted total hip arthroplasty (RO THA) compared with the conventional technique (CO THA).

This large-scale, single-institution study included 1,607 patients of any age who underwent 1,732 primary THAs for any indication between May 2019 and January 2023. The data which were collected included the demographics of the patients, LOS, type of anaesthetic, the need for treatment in a post-anaesthesia care unit (PACU), readmission within 30 days, and discharge disposition. Univariate and multivariate logistic regression models were used to identify factors and the characteristics of patients which were associated with delayed discharge.

The multivariate model identified that age, female sex, admission into a PACU, American Society of Anesthesiologists grade > II, and CO THA were associated with a significantly higher risk of a LOS of > two days. The median LOS was 54 hours (interquartile range (IQR) 34 to 78) in the RO THA group compared with 60 hours (IQR 51 to 100) in the CO THA group (p < 0.001). The discharge dispositions were comparable between the two groups. A higher proportion of patients undergoing CO THA required PACU admission postoperatively, although without reaching statistical significance (7.2% vs 5.2%, p = 0.238).

We found that among other baseline characteristics and comorbidities, RO THA was associated with a significantly shorter LOS, with no difference in discharge destination. With the increasing demand for THA, these findings suggest that robotic assistance in THA could reduce costs. However, randomized controlled trials are required to investigate the cost-effectiveness of this technology.

This study evaluated the accuracy of the cup alignment angles and spatial cup positioning on computed tomography (CT) images in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty (THA) using a minimally invasive technique via an anterolateral approach in the supine position according to whether a robotic arm-assisted system or a CT-based navigation system was used.

We reviewed 60 robotic arm-assisted (RA)-THA cases and 174 navigation-assisted (NA)-THA cases. After propensity score matching, there were 52 hips in each group. Postoperative cup alignment angles and position were assessed by superimposition of a three-dimensional cup template onto the actual implanted cup using postoperative CT images with pelvic coordinates matching the preoperative planning.

The mean absolute error of the inclination angle and the anteversion angle between the preoperative planning and the postoperative measurement was significantly smaller in the RA-THA group (inclination, 1.1° ± 0.9; anteversion, 1.3° ± 1.0) than in the NA-THA group (inclination, 2.2° ± 1.5; anteversion, 3.3° ± 2.5). For acetabular cup positioning, the mean discrepancy between the preoperative planning and the postoperative measurement was 1.3 ± 1.3 mm on the transverse axis, 2.0 ± 2.0 mm on the longitudinal axis, and 1.3 ± 1.7 mm on the sagittal axis in the RA-THA group and 1.6 ± 1.4 mm, 2.6 ± 2.3 mm, and 1.8 ± 1.3 mm, respectively, in the NA-THA group. High precision of cup positioning was observed in both groups with no statistically significant difference.

Robotic arm-assisted THA using a minimally invasive technique via an anterolateral approach in the supine position allows accurate cup placement in patients with DDH.

Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid.

Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated.

Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative haemoglobin decrease of 3.08±1.08g/dl, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 months).

Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid.

Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated.

Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4month).

Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total joint arthroplasty among minority groups. As an imperative effort to close the gap regarding health inequalities, we assessed the knowledge and perspective of Hispanics regarding robotic-assisted orthopaedic surgery.

A 28-item questionnaire was established to evaluate Hispanics' perceptions of robotic-assisted orthopaedic surgery. Participants answered questions about demographic features, knowledge about robotic-assisted orthopaedic surgery, and preferences regarding manual vs robotic-assisted procedures.

A total of 580 questionnaires were analyzed in our study, with an average age of participants of 49.1 years. Only 44.2% of the participants were familiar with robotic-assisted orthopaedic surgery. Fifty-three percent of the respondents preferred robotic-assisted surgery over conventional procedures, with many participants believing that robotic-assisted surgery leads to better outcomes (54.7%) and faster recovery (53.1%).

Knowledge about specific factors such as clinical outcomes and costs may influence the perception and preference of Hispanics toward robotic-assisted orthopaedic surgery. Therefore, patient education may play a crucial role in the informed decision-making process in Hispanics when opting between robotic-assisted or traditional orthopaedic surgery.

Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/-1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.

While robotic-assisted total hip arthroplasty (RA-THA) has been associated with improved accuracy of component placement, the perioperative and early postoperative outcomes of fluoroscopy-based RA-THA systems have yet to be elucidated.

This retrospective cohort analysis included a consecutive series of patients who received manual, fluoroscopy-assisted THA (mTHA) and fluoroscopy-based RA-THA at a single institution. We compared rates of complications within 90 days of surgery, length of hospital stay (LOS), and visual analog scale (VAS) pain scores.

No differences existed between groups with respect to demographic data or perioperative recovery protocols. The RA-THA cohort had a significantly greater proportion of outpatient surgeries compared to the mTHA cohort (37.4% vs. 3.8%; p < 0.001) and significantly lower LOS (26.0 vs. 39.5 h; p < 0.001). The RA-THA cohort had a smaller 90-day postoperative complication rate compared to the mTHA cohort (0.9% vs. 6.7%; p = 0.029). The RA-THA cohort had significantly lower patient-reported VAS pain scores at 2-week follow-up visits (2.5 vs. 3.3; p = 0.048), but no difference was seen after 6-week follow visits (2.5 vs. 2.8; p = 0.468).

Fluoroscopy-based RA-THA demonstrates low rates of postoperative complications, improved postoperative pain profiles, and shortened LOS when compared to manual, fluoroscopy-assisted THA.

Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance.

Total hip arthroplasty (THA) has revolutionized the treatment of hip joint arthritis. With the increased popularity and success of the procedure, research has focused on improving implant survival and reducing surgical complications. Optimal component orientation has been a constant focus with various philosophies proposed. Regardless of the philosophy, achieving an accurate acetabular position for each clinical scenario is crucial. In this paper, we review the recent developments in improving the accuracy and ideal positioning of the acetabular cup in routine primary THA.

A review of the recent scientific literature for acetabular cup placement in primary THA was performed, with available evidence for safe zones, spinopelvic relationship, preoperative planning, patient-specific instrumentation, navigation THA and robotic THA.

Though the applicability of Lewinnek safe zones has been questioned with an improved understanding of spinopelvic relationships, its role remains in positioning the acetabular cup in a patient with normal spinopelvic alignment and mobility. Evaluation of spinopelvic relationships and accordingly adjusting acetabular anteversion and inclination can significantly reduce the incidence of dislocation in patients with a rigid spine. In using preoperative radiography, the acetabular inclination, anteversion and intraoperative pelvic position should be evaluated. With improving technology and the advent of artificial intelligence, superior and more accurate preoperative planning is possible. Patient-specific instrumentation, navigated and robotic THA have been reported to improve accuracy in acetabular cup positioning as decided preoperatively but any significant clinical advantage over conventional THA is yet to be elucidated.

Robotic-assisted orthopedic surgery (RAOS) is revolutionizing the field, offering the potential for increased accuracy and precision and improved patient outcomes. This comprehensive review explores the historical perspective, current robotic systems, advantages and limitations, clinical outcomes, patient satisfaction, future developments, and innovation in RAOS. Based on systematic reviews, meta-analyses, and recent studies, this article highlights the most significant findings and compares RAOS to conventional techniques. As robotic-assisted surgery continues to evolve, clinicians and researchers must stay informed and adapt their practices to provide optimal patient care. Evidence from published studies corroborates these claims, highlighting superior component positioning, decreased incidence of complications, and heightened patient satisfaction. However, challenges such as costs, learning curves, and technical issues must be resolved to fully capitalize on these advantages.

Several implant manufacturers have developed ultra-porous metal substrate acetabular components recently. Despite this, data on clinical and radiographic outcomes remain limited. Our study evaluated postoperative patient-reported outcome measures (PROMs) and radiographic analyses in patients fitted with a novel acetabular porous-coated component.

A total of 152 consecutive patients underwent a total hip arthroplasty by a single orthopaedic surgeon. All patients underwent surgery utilizing the same CT-scan based robotic-assisted device with the same porous cementless acetabular shell. They received standardized postoperative physical therapy, rehabilitation, and pain protocols. Preoperatively, first postoperative visit, 6-months, 1-year, and 2-years, patients were evaluated based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, physical function, and total scores; 2) Patient-Reported Outcomes Measurement Information System (PROMIS)-10 physical and mental scores; 3) Hip Disability and Osteoarthritis Outcome Score (HOOS)-Jr scores; as well as 4) acetabular component positions and 5) evidence of acetabular component loosening.

Significant improvements were observed by 6 months in WOMAC pain, physical function, and total scores (p < 0.05), maintained at 1 and 2 years. PROMIS-10 physical scores also improved significantly from preoperative to 6 months postoperative and remained so at 1 and 2 years postoperative (p < 0.05). No significant changes were found in PROMIS-10 mental scores. HOOS-Jr scores significantly improved from preoperative to 6 months postoperative and remained so through 2 years (p < 0.05). At 6 months, slight changes were noted in abduction angle and horizontal and vertical offset. Radiolucencies, initially found in 3 shells, reduced to 1 shell with 2 new radiolucencies by 6 months, and remained stable with no subsequent operative interventions. At 1 year and 2 years, no radiographic abnormalities were noted, including complete resolution of prior radiolucencies as well as stable components.

This porous cementless acetabular shell, implanted with CT-scan-based robotic-assisted techniques, demonstrated excellent postoperative PROMs at 2 years. Stable radiolucencies suggest good component stability. The early stable clinical and radiographic results suggest promising long-term outcomes with this device.

III (retrospective cohort study).

Total hip arthroplasty (THA) is a successful surgical method for hip replacement but still poses challenges and risks. Robotic-assisted THA (rTHA) using new generation robotic systems has emerged to improve surgical precision and outcomes. The purpose of this paper is to review the literature on rTHA, with a focus on its advantages, such as individualized preoperative planning, intraoperative assistance, and improved accuracy in implantation, especially in complex cases. Additionally, it aims to explore the disadvantages associated with the use of rTHA, including high costs, the learning curve, and prolonged operation time compared to manual THA (mTHA), which are critical drawbacks that require careful consideration and efforts for minimization. Some financial analyses suggest that rTHA may offer cost-effectiveness and reduced postoperative costs compared to mTHA. While technological advancements are expected to reduce technical complications, there are still debates surrounding long-term outcomes. Practical limitations, such as limited availability and accessibility, also warrant attention. Although the development of rTHA shows promise, it is still in its early stages, necessitating critical evaluation and further research to ensure optimal patient benefits.

Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty.

A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics."

After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies.

The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.

Accurate acetabular cup position remains a persistent challenge in total hip arthroplasty (THA). Studies investigating the early outcomes of robotic-assisted THA (RA-THA) systems have shown improved cup placement compared to manual THA (mTHA) approaches, however, contemporary robotic platforms are reliant on pre-operative CT imaging. The goal of this study was to analyze the accuracy of a novel, fluoroscopy-based RA-THA system compared to an unassisted mTHA approach and determine the effect of the robotic system on operative time. We performed a retrospective cohort analysis on a consecutive series of 198 patients who received mTHA and RA-THA between March 2021 and July 2022. The primary outcome of interest was the accuracy of acetabular component placement, defined by average cup inclination and anteversion. Secondary outcomes included the proportion of acetabular cups positioned within the Lewinnek safe zone, operative time, and overall room time. The RA-THA group demonstrated significantly higher accuracy of acetabular anteversion to target compared to the manual group (18.5 vs. 21.7˚; p < 0.001), and had a significantly greater proportion of acetabular cups placed within the Lewinnek safe zone (81.6 vs. 59.0%; p < 0.001). The RA-THA cohort had longer operative times compared to mTHA group (39.0 vs. 35.3 min; p = 0.003), but no difference was seen in total operating room time (101.2 vs. 101.2 min; p = 0.982). This study demonstrates that the use of a novel, fluoroscopy-based, pin-less THA robotic platform increased the accuracy of acetabular cup placement, including a 22.6% improvement in safe zone placement, compared to mTHA approach, with no increase in overall case time.

Robotic-arm assisted total hip arthroplasty (RO THA) has been shown to improve the accuracy of component positioning compared with conventional total hip arthroplasty (CO THA). This study reports Patient-Reported Outcome Measures (PROMs) of a previous trial that showed that RO THA was associated with improved accuracy and reduced outliers in acetabular component positioning compared with CO THA.

This prospective cohort study included 50 patients undergoing CO THA versus 50 patients receiving RO THA. The Oxford hip score, Forgotten Joint Score (FJS), University of California at Los Angeles hip score were recorded at a minimum of 3 years following surgery.

At minimum 3 years follow-up, there was no statistically significant difference in CO THA versus RO THA with respect to the Oxford hip score [median 42(6.25) versus 41(5.5), P = .914]; FJS [89 (9.25) versus 86 (9), P = .065], and University of California at Los Angeles score [median 7.5 (3) versus 7 (2), P = .381]. None of the study patients had dislocations or underwent revision surgery within 3 years follow-up.

The previously reported improvement in accuracy of acetabular component in this study population did not translate to statistically significant improvements in PROMs. Patients in both groups achieved excellent PROMs and there was a trend towards higher FJS scores postoperatively in the RO THA group that did not reach statistical significance. Further studies are needed to assess the significance of these findings on longer-term clinical outcomes and implant survivorships, and also to explore the impact of the enhanced RO THA workflow and functional implant positioning on these outcomes.

Robot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).

Four electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.

A total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek's and Callanan's safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.

RA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

It may be possible to extend the use of the robotic arm to pelvic and acetabular surgery leading to safe, repeatable screw placement, and less radiation exposure for patients, surgeons and OR staff.

In this case, a novel, robotic-assisted technique was used to place a sacroiliac screw in a patient with unstable injuries of the pelvic ring. Intraoperative and postoperative fluoroscopic, radiographic, and CT imaging demonstrated a safely positioned 6.5 mm cannulated screw without unplanned cortical violation or impingement on neurovascular structures. To our knowledge, this is the first such reported case using a robot widely available in the Americas or Europe.

In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the intention of orthopedic doctors to integrate new medical technologies. The survey was based on a questionnaire that was used for data collection. The quantitative study registered a sample of 145 orthopedic doctors. The data analysis was performed based on the IBM SPSS program. A multiple linear regression model was applied, which analyzed how the independent variables can influence the dependent variables. After analyzing the data, it was observed that the intention of orthopedic doctors to use new medical technologies is influenced by the advantages and disadvantages perceived by them, the perceived risks, the quality of the medical technologies, the experience of physicians in their use, and their receptivity to other digital tools. The obtained results are highly important both for hospital managers and authorities, illustrating the main factors that influence doctors to use emergent technologies in their clinical work.

Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [Orthopedics. 2023;46(1):39-46.].

This current concepts article reviews the literature pertaining to the use of robot-assisted systems in total hip arthroplasty (THA). The bulk of the literature is regarding the MAKO (currently the most used system worldwide) and the historic ROBODOC robotic systems. There is a paucity of literature available on other systems, with several still in pilot-phase development. Whilst the evidence shows improved radiological outcomes with robotic THA, functional outcomes are equivocal between conventional and robotic techniques. Acceptance of robotic THA worldwide is limited by its accessibility including cost, and by already exceptional results with the conventional technique. It is, however, a rapidly developing area of orthopaedic surgery. This article discusses the history of robotics in THA, current surgical techniques, functional and radiological outcomes, and ongoing avenues for development.

Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived "safe zones"; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients' phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction.

Robotic-assisted total hip arthroplasty (R-THA) affords precision yet uncertain clinical benefits. This study compares dislocation rates and related revisions between R-THA and manual total hip arthroplasty (M-THA). Secondarily we evaluated cup position, patient-reported outcome measures (PROMs), and postoperative complications.

A three-surgeon cohort study was conducted on 2247 consecutive patients (1724 M-THA and 523 R-THA) who received a primary THA between January 2014 and June 2020 at a single hospital. Demographics, PROMs, emergency department visits, readmissions, and 90-day complications were collected via the Michigan Arthroplasty Registry Collaborative Quality Initiative. Chart review yielded instability occurrence with an average follow-up of 4 years. Multivariate regression analysis was performed, and a sample of 368 radiographs, including all dislocations, were assessed.

There were significantly lower rates of dislocation in R-THA (0.6%) vs M-THA (2.5%; Multivariate odds ratio 3.74, P < .046). All cases of unstable R-THA were successfully treated conservatively, whereas 46% of unstable M-THA were revised for recurrent instability. Cup anteversion (25.6° ± 5.4° R-THA vs 20.6° ± 7.6° M-THA) was greater, and cup inclination (42.5° ± 5.3° R-THA vs 47.0° ± 6.7° M-THA) was lower in the R-THA group (P < .05). No significant differences were noted for demographics, PROMs, or other complications (P > .05).

R-THA resulted in less than one-fourth the dislocation rate compared to M-THA and no revision for instability. It was associated with no difference in PROMs or other early complications. The influence of R-THA on stability goes beyond simply cup positioning and deserves further study.

Accurate component orientation and restoration of hip biomechanics remains a continuing challenge in total hip arthroplasty (THA). The goal of this study was to analyze the accuracy/reproducibility of a novel CT-free and pin-less robotic-assisted THA (RA-THA) platform compared to manual THA (mTHA). This matched-pair cadaveric study compared this RA-THA system to mTHA (n = 33/arm), both using the assistance of fluoroscopic imaging, in a group of 14 high-volume arthroplasty surgeons. In both groups, surgeons were asked to aim for 40°/15° for cup inclination/version, and 0 mm of leg length discrepancy (LLD). A validated and accurate method using radio-opaque markers measured cup inclination/version and LLD. The accuracy and reproducibility (fewer outliers) of cup inclination was significantly improved in the robotic group (1.8° ± 1.3° vs 6.4° ± 4.9°, respectively, robotic vs manual; p < 0.001), with no significant difference between groups for version. The reproducibility of LLD was significantly improved in the robotic group (p = 0.003). For all parameters studied, the robotic group had an improved accuracy and lower variance (fewer outliers). The percentage of cases within the more restrictive Callanan safe zone was 100% for RA-THA vs 73% for mTHA (p = 0.002). The CT-free RA-THA platform, using only fluoroscopic imaging, demonstrated more accurate acetabular cup positioning, when compared to the mTHA procedures performed by high-volume hip surgeons (naive to this RA-THA platform), with respect to cup inclination and placement within the Lewinnek/Callanan safe zones. Future study must incorporate economic factors, lower volume surgeons, clinical and patient-centric outcomes, and other radiographic parameters in controlled studies in large sample sizes.