Implementation of Robotic-Assisted Procedure for Total Hip Arthroplasty Is Not Economical in a High-Volume Orthopaedic Facility

Abstract

BACKGROUND: Advances in elective primary total hip arthroplasty (THA) have led to the use of robotic assistance and computer navigation during surgery; recent reports have demonstrated substantial benefits of this technology. However, few studies have made a head-to-head comparison of technology with a specific focus on patient-reported outcomes (PROs) when preoperative patient profiles are well controlled. Therefore, the purpose of this study was to compare outcomes among patients who underwent conventional, robotic-assisted, and computer-navigated procedures. METHODS: This retrospective study included patients aged 25 to 89 years who underwent THAs between January 2020 and May 2025. Patients were matched on age, body mass index (BMI), Charlson Comorbidity Index (CCI), and preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and were assigned to study groups based on the technology used: (1) conventional, (2) robotic-assisted, and (3) computer-navigated. Postoperative recovery metrics between groups were compared up to 1 year from the surgery. RESULTS: A total of 3799 patients were included: 2582 (68%) in the conventional group, 389 (10%) in the robotic-assisted group, and 828 (22%) in the computer-navigated group. PROs improved with no differences between groups by 12 months but showed slightly slower recovery in computer-navigated cases. Complication rates (return to operating room and hospital readmittance) were similar in all groups. Both robotic-assisted surgery and computer-navigated procedures cost around $1000 more than the conventional procedure, with robotic-assisted procedures taking 3 minutes longer than conventional procedures (P < 0.05). CONCLUSION: Despite added cost, the technology-assisted procedures did not offer substantial improvements to surgical outcomes when used in primary THAs in a high-volume orthopaedic hospital. When controlled by matching demographics, comorbidities, and PROs, the technology-supported THA patients had no clinically relevant differences in postoperative outcomes and had higher hospital utilization compared with the conventional group.