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Published on: September 7, 2022
Robotic-Assisted Total Hip Arthroplasty Is Associated With Fewer Intraoperative Conversions From a Neutral to a
Peter P Hsiue1, Billy I Kim1, Ryan Cheng1
1Hospital for Special Surgery, New York, NY, USA.
Background:
Robotic assistance is becoming increasingly popular among surgeons performing total hip arthroplasty (THA). The impact of robotic assistance on the assessment of intraoperative stability and acetabular liner selection is not well described.
Purpose:
We sought to compare the incidence of intraoperative conversion from a neutral liner to a non-neutral liner in patients undergoing either robotic-assisted THA or manual THA.
Methods:
We conducted a retrospective cohort study of patients who underwent primary THAs at our institution between January 1, 2018 and June 30, 2022. Partial hip arthroplasties, simultaneous bilateral hip arthroplasties, revision surgeries, and navigation-guided THAs were excluded. We identified 9614 primary THAs performed on 8807 patients; of these, 3875 were robotic-assisted THAs and 5739 were manual THAs. Liners were subcategorized into implanted versus wasted and neutral versus non-neutral (eg, elevated, lipped, lateralized, face changing, true constrained, and dual mobility). The primary outcome was the rate of intraoperative conversion from a neutral to non-neutral liner, defined as a wasted neutral liner followed by the implantation of a non-neutral liner.
Results:
Neutral liners were more frequently used in robotic-assisted THA than in manual THA (71% vs 42%, respectively), whereas elevated or lipped liners were more commonly used in manual THA than in robotic-assisted THA (34% vs 26%, respectively). After controlling for patient demographics and surgical variables, robotic-assisted THA had lower odds of conversion from a wasted neutral to an implanted non-neutral liner compared to manual THA.
Conclusion:
Robotic-assisted THA is associated with a decreased rate of intraoperative liner conversion from a neutral to a non-neutral liner, suggesting that robotic assistance may provide greater stability during intraoperative assessments of implant placement.
Level Of Evidence:
Level III: retrospective cohort study.
