Robotic assistance is associated with improved surgical efficiency during direct anterior total hip arthroplasty

The direct anterior (DA) approach allows for earlier mobilization and shorter length-of-stay than traditional total hip arthroplasty (THA) approaches; however, conventional techniques rely on intraoperative fluoroscopy for accurate cup placement. Robotic-assisted THA is an alternative to conventional THA procedures and utilizes preoperative computed tomography (CT) scans and intraoperative mapping for accurate component positioning. The purpose of this study was to evaluate the impact of robotic-assisted DA THA without fluoroscopy on surgical efficiency parameters when compared to conventional DA THA with fluoroscopy.

There were six cadaver specimens evenly distributed between two orthopaedic surgeons, both with previous experience in conventional and robotic-assisted THA. For each cadaver, conventional DA THA with fluoroscopy was performed on the first hip, and robotic-assisted DA THA without fluoroscopy was performed on the contralateral hip. Total surgical time from skin to trials, acetabular and femoral workflow time, and the number of reamers and broaches used, were recorded for all cases. There were two-sample t-tests performed to assess statistical differences between conventional and robotic-assisted THA data.

Acetabular reaming took longer, on average, for conventional DA THA with fluoroscopy than robotic-assisted DA THA without fluoroscopy (2.4 ± 0.6 versus 0.4 ± 0.2 min; p < 0.001). Surgeons using conventional THA required more acetabular reamers when compared to a single reamer used with robotic-assisted THA (2.67 ± 0.5 versus 1 ± 0; p = 0.001). Total operative time (26.1 ± 7.0 versus 23.2 ± 5.6 min; p = 0.452), acetabular workflow time (6.4 ± 3.1 versus 3.3 ± 1.7 min; p = 0.07), femoral workflow time (6.5 ± 4.8 versus 5.0 ± 1.7 min; p = 0.495), and number of femoral broaches (5.0 ± 1.8 versus 4.3 ± 2.3; p = 0.593) were higher during conventional THA than during robotic-assisted THA.

Amidst the changing healthcare environment and focus on identifying and implementing efficiencies, these findings have important consequences for the continued and accelerated use of robotic-assisted THA in primary settings.