Manual and Robotic Assisted Total Hip Arthroplasty: An Analysis of Peri-operative and Post-Operative Complications

Abstract

Introduction: Robotic-assisted total hip arthroplasty usage has been rising among surgeons. This study aims to compare the difference between manual versus robotic-assisted total hip arthroplasty (RA-THA) short-term peri-operative and post-operative complications. Given improved acetabular component placement, we hypothesize that RA-THA is associated with the risk of lower overall complications and fewer revision surgical interventions compared to manual.

Methods: A non-randomized, single-institution, retrospective study was conducted utilizing a single electronic health record database. 404 robotic-assisted and 3,876 manual, posterior lateral approach total hip arthroplasty cases from March 2018 to June 2022 were included. We compared complications within one year of the index procedure including dislocations, infection, intraoperative acetabular fractures, cup loosening, leg length discrepancy, pin track-related complications, reoperations, and peri-operative complications.

Results: We analyzed system based, 90-day post operative complications in both groups.Further, we specifically aimed to identifyspecific complications resulting in repeat operation within 1 year of index procedure. Overall complications between the groups were 14.1% vs 20.9% (p=.005), RA THA vs manual THA respectively.There was no evidence of acetabular fractures or cases of cup loosening. R-THA also carried an increased OR (OR [95%] =1.696 [0.986 – 2.916], p=0.056) for requiring revision surgery but the result was not statistically significant.

Conclusions: When comparing RA-THA and M-THA, there is acomparable risk revision surgery associated with dislocation and periprosthetic joint infection within 1 year of index surgery, with a higher rate of periprosthetic fracture in the R-THA group. There was no significant difference in operating time and a higher rate of overall complications in the M-THA group. No complications were found with the pin tracts.

Keywords: Total Hip Arthroplasty (THA); Manual/Conventional THA (CTHA); Robotic Assisted THA (RATHA); Electronic Medical Record (EMR); Peri-operative complications; Post-operative complications

Citation

Kloc A, Ferrante S, Ozdag Y, Patil S. Manual and Robotic Assisted Total Hip Arthroplasty: An Analysis of Peri-operative and Post Operative Complications. WebLog J Musculoskelet Disord. wjmd.2026. a0103. https://doi.org/10.5281/zenodo.18211524