Robot-Assisted Total Hip Arthroplasty Versus Conventional Surgery in Terms of Surgical Accuracy, Function, Trauma, and Complications: A Prospective, Multicenter, Parallel-Group, Open-Label Randomized Controlled Trial.

Abstract

The primary aim of this study was to compare the accuracy of component positioning between robotic-assisted total hip arthroplasty (R-THA) and manual total hip arthroplasty (M-THA) and to determine whether there are differences in achieving the minimal clinically important improvement (MCII) in functional outcomes. In addition, surgical trauma and complications were also compared. This study included 132 patients from three centers who were randomly assigned to either the R-THA group or the M-THA group. The absolute errors in predicting component size, acetabular component position, limb-length discrepancy, hip offset, and center of rotation were compared. In addition, the Harris Hip Scores at three months postoperatively and one year postoperatively, as well as the proportion of patients who achieved MCII, were compared. The blood loss, inflammatory markers, and complications were also compared between the groups. The absolute errors for the abduction and anteversion angles in the R-THA group were smaller than those in the M-THA group (P < 0.05). The proportion of patients who had cups in the Callanan safe zone was greater in the R-THA group (P < 0.05). In addition, the R-THA group outperformed the M-THA group in controlling limb-length discrepancy and hip offset (P < 0.05). The R-THA demonstrated significantly greater accuracy in predicting component size (P < 0.05). Although R-THA patients had higher Harris Hip Scores at three and 12 months postoperatively, there was no significant difference in the proportion of patients who achieved an MCII (P > 0.05). The R-THA group had a shorter operative time, but there was no difference in blood loss, inflammatory response, or complications. Compared to manual THA, R-THA improves surgical accuracy without increasing surgical trauma, contributing to the restoration of the patient's original hip biomechanics. However, it does not offer an advantage in achieving the MCII postoperatively.