Robotic Outcome Study: “More Quality Data, Please!”

A team from the Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo, Michigan, has found a pretty big hole in the literature. Their work, “Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review,” was published in the June 2021 edition of JBJS Reviews.

“There is a growing body of orthopaedic literature evaluating the adoption and use of robotic technology in total joint arthroplasty,” co-author Matthew Sweet, M.D. explained to OTW. “As a junior orthopaedic resident, I had a baseline familiarity with robotic total knee arthroplasty, however, my understanding of the current evidence for robotic technology in total hip arthroplasty (THA) was limited.”

“The purpose of this study was to systematically review the available evidence comparing robotic THA to conventional THA, and to specifically examine patient outcomes and complications rates between the two techniques.”

The research team found 7 studies representing data from 658 patients, of whom 335 had been treated with robotic assist total hip arthroplasty. Most of the evidence from the studies showed that there were no significant differences in patient reported outcome measures (PROMs) between robotic assist and non-robotic assist hip surgeries. The researchers also noted that two studies, both Level III and lower quality, reported significantly better postoperative PROMs favoring robotic THA at two years.

“When assessing radiographic outcomes, 6 studies showed that robotic THA resulted in more consistent and accurate component placement,” wrote the authors. “No differences in postoperative dislocations, complications, or revision rates were found between groups except in 1 study, which found significantly more dislocations and revisions in the robotic THA cohort. Reported operative times were a mean of 12 to 25 minutes longer when using robotic THA.”

“The most important finding of this review,” explained Dr. Sweet to OTW, “is that there is a paucity of high-quality evidence comparing robotic THA and manual THA. Although evidence exists to support increased accuracy and reproducibility of THA component placement with robotic THA, this has not been shown to reduce postoperative dislocation rates. Based on the available evidence, functional outcomes are comparable between techniques and robotic THA appears to be associated with longer operative times.”

Baby Robot Steps

“Our understanding of robotic THA is currently in its infancy, and orthopaedic surgeons and trainees are likely to encounter robotic technology in their practices in the years to come. Further prospective, high-quality research is warranted to evaluate the utility of robotic THA, and orthopaedic surgeons must continue to critically assess the impact and value of new technology on patient outcomes and ensure it is supported by robust evidence.”

“This systematic review aimed to present an updated analysis of the evidence comparing outcomes between robotic-assisted total hip arthroplasty and conventional manual total hip arthroplasty.”