Robotics improves reproducibility of component positioning while producing modest but measurable clinical benefits in total hip arthroplasty: an umbrella review of systematic reviews and meta-analyses

Robotic-assisted total hip arthroplasty (RTHA) promises enhanced implant positioning precision versus conventional THA (CTHA), potentially lowering complications, though evidence from systematic reviews remains inconsistent. The present umbrella review investigates the efficacy of RTHA over CTHA. This umbrella review followed Cochrane guidelines. PubMed, Scopus, and Cochrane Library were accessed. Eleven reviews were included after PRISMA screening. Data on complications, revisions, operative time, leg-length discrepancy (LLD), Forgotten Joint Scores, and alignment (safe zones, cup inclination/anteversion, delta-HCOR/VCOR) were extracted independently. AMSTAR-2 was used to assess methodological quality. The mean difference (MD) and odds ratio (OR) were used, with 95% confidence intervals (CIs). RTHA improved Lewinnek safe-zone placement (OR 7.37, 95% CI 5.51–9.86) and Callanan zone (OR 7.20, 95% CI 5.42–9.55), reduced complications (OR 0.60, 95% CI 0.41–0.87), LLD (MD –1.60 cm, 95% CI –2.30 to -0.90), and Forgotten Joint Scores (MD –6.82, 95% CI –9.81 to –3.83), but increased operative time (MD 15.66 min, 95% CI 10.91–20.41). No differences emerged in revisions (OR 1.08), cup inclination/anteversion, or delta-VCOR. Robust fail-safe N supported findings; funnel asymmetry varied. RTHA enhances precision and reduces short-term complications compared with CTHA, despite longer operative times. Selective use is recommended for high-risk misalignment cases; long-term, cost-effectiveness RCTs are needed.