Comparison of Surgical Time, Short-term Adverse Events, and Implant Placement Accuracy Between Manual, Robotic-assisted, and Computer-navigated Total Hip Arthroplasty: A Network Meta-analysis of Randomized Controlled Trials

Abstract

Introduction: Recent years have observed the increasing utilization of robotic-assisted and computer navigation techniques in total hip arthroplasty (THA), given the proposed benefits of enhanced consistency and precision in implant placement. The purpose of this study was to conduct a systematic review of randomized controlled trials (RCTs) to determine whether differences in surgical times, adverse events, and implant positioning existed between manual, robotic-assisted, and computer navigation THA. Methods: PubMed, OVID/MEDLINE, and Cochrane databases were queried for RCTs comparing robotic-assisted versus manual THA and computer navigation versus manual THA at a minimum 1-year followup. Frequentist model network meta-analyses with P-scores were conducted to compare revisions, complications, and surgical times among the three treatment groups. A random-effects meta-analysis between computer navigation and manual THAs was conducted to analyze cup positioning because no robotic-assisted THA studies reported this outcome. Results: Five RCTs compared robotic-assisted and manual THAs, while seven compared computer navigation and manual THAs. manual THA was associated with significantly reduced surgical time in comparison with computer navigation (mean difference: 23.3 minutes) and roboticassisted THAs (mean difference: 8.6 minutes; P , 0.001). No difference was observed in the incidence of all-cause complications (computer navigation: 1.7%, manual: 6.6%, and robotic-assisted: 16.2%) or revisions (computer navigation: 1.0%, manual: 1.7%, and roboticassisted 4.8%) among the three treatment groups based on the network meta-analysis. In three studies that reported acetabular implant

Assessing ChatGPT Responses to Common Patient Questions Regarding Total Hip Arthroplasty

“…The chatbot correctly identified the typical duration of a THA procedure as well as the possible variance as a result of surgical techniques [5][6][7][8][9] , surgeon experience [10][11][12][13][14] , and patient characteristics. For instance, operative time is significantly affected by patient body mass index [13][14][15][16] .…”

Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: A translational study

“…Interestingly robotic surgeries are longer and require a steeper learning curve (Royal College of Surgeons 2018). In orthopedics and spine surgery, in particular, the use of surgical robots has increased the accuracy of placement of knee and hip prosthesis and osteosynthesis screws into defined "safe zones" (Kunze et al, 2022).…”

“…Interestingly robotic surgeries are longer and require a steeper learning curve (Royal College of Surgeons 2018). In orthopedics and spine surgery, in particular, the use of surgical robots has increased the accuracy of placement of knee and hip prosthesis and osteosynthesis screws into defined “safe zones” (Kunze et al, 2022). Capturing the benefits in terms of increased longevity of the prosthesis or decreased need for revision surgery, however, has been an elusive goal (Kumar et al, 2021; Nogalo et al, 2023).…”

The learning curve for a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty system

“…The majority of current RA‐THA systems rely on pre‐operative computed tomography (CT) imaging and intraoperative navigation tracker pins to guide the robotic platform, which can prolong pre‐operative and intra‐operative workflows 3,19,20 . However, novel fluoroscopy‐based robotic platforms aim to address these issues through the replacement of pre‐operative CT imaging with the integration of intraoperative fluoroscopy, which removes the need for additional pre‐operative imaging and intraoperative surgical pin placement 3 .…”

“…[15][16][17][18] The majority of current RA-THA systems rely on pre-operative computed tomography (CT) imaging and intraoperative navigation tracker pins to guide the robotic platform, which can prolong preoperative and intra-operative workflows. 3,19,20 However, novel fluoroscopy-based robotic platforms aim to address these issues through the replacement of pre-operative CT imaging with the integration of intraoperative fluoroscopy, which removes the need for additional pre-operative imaging and intraoperative surgical pin placement. 3 While a cadaveric study has shown improved accuracy of acetabular cup placement with a fluoroscopy-based robotic platform compared to an unassisted approach, 3 no group has examined this novel fluoroscopy-based RA-THA system in clinical practice.…”