Article Text

Download PDFPDF
Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis
  1. Vishal Kumar,
  2. Sandeep Patel,
  3. Vishnu Baburaj,
  4. Rajesh Kumar Rajnish,
  5. Sameer Aggarwal
  1. Orthopedic Surgery, PGIMER, Chandigarh, India
  1. Correspondence to Dr Vishnu Baburaj, Orthopedic Surgery, PGIMER, Chandigarh, India; drvbms{at}


Background Robot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).

Methods Four electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.

Results A total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek’s and Callanan’s safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.

Conclusion RA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • VK and SP are joint first authors.

  • Contributors VK conceptualised and planned the study and did data extraction. SP conducted preliminary searches, made the study protocol and did data extraction. VB conducted detailed searches, obtained full text of relevant articles, prepared and submitted the manuscript. RKR did the risk of bias assessment and assisted in data extraction and inclusion or exclusion of articles. SA conducted the meta-analysis and did overall supervision and critical review of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.