Robotic-Assisted Total Hip Arthroplasty Compared With Manual Techniques: A Systematic Review and Meta-Analysis of Operative Time, Complications, and Functional Outcomes

TL;DR

Robotic-assisted hip surgery reduces complications but takes longer than manual techniques, with no significant difference in short-term patient outcomes.

Contribution

The study provides a meta-analysis comparing robotic and manual hip surgery, highlighting complication reduction and operative time differences.

Findings

Robotic-assisted surgery had 51% fewer complications compared to manual techniques.

Operative time was 8.43 minutes longer for robotic-assisted procedures.

No significant differences were found in implant dislocation rates or functional outcomes.

Abstract

This systematic review and meta-analysis evaluated the comparative effectiveness and safety of robotic-assisted versus manual total hip arthroplasty by analysing 15 comparative studies. A comprehensive literature search was conducted across multiple databases from January 2010 to December 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing robotic-assisted and conventional manual total hip arthroplasty in primary procedures were included, with data extracted on operative time, perioperative complications, implant dislocation rates, and functional outcomes using the Harris Hip Score. Meta-analysis revealed that robotic-assisted total hip arthroplasty required significantly longer operative times compared with manual techniques, with a mean difference of 8.43 minutes. However, robotic-assisted procedures demonstrated a clinically meaningful 51% reduction in overall perioperative complications compared with manual techniques, with low heterogeneity among studies. This reduction may result from enhanced precision in component positioning, real-time haptic feedback preventing inadvertent bone resection, and improved soft tissue preservation.

No significant differences were observed between groups with regard to implant dislocation rates or Harris Hip Score outcomes, suggesting that enhanced surgical precision does not necessarily translate into superior short-term functional outcomes. These findings indicate that while robotic-assisted total hip arthroplasty offers potential advantages in reducing complications, the increased operative time and substantial capital investment require careful consideration. The technology may be particularly beneficial for high-risk patients or complex cases. Future research should focus on long-term outcomes, cost-effectiveness analyses, and identification of specific patient subgroups who may derive maximum benefit from robotic assistance, to inform appropriate clinical utilisation of this technology.

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