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PURPOSE: Robotic assisted total hip arthroplasty (RA-THA) has been introduced to improve the precision of implant positioning and potentially enhance outcomes in THA. However, large scale national data on its real-world impact are lacking. This study presents the first nationwide analysis of RA-THA using the National Inpatient Sample (NIS), evaluating trends in adoption and comparing perioperative outcomes between RA-THA and conventional THA. METHODS: We performed a retrospective cohort study using the NIS (2016–2022). Adult patients undergoing primary elective THA were identified, and those with robotic assistance were classified using ICD-10 procedural codes for robot-assisted surgery. Propensity score matching (1:1) was employed to create comparable cohorts of RA-THA vs. conventional THA, controlling for patient demographics, hospital characteristics, and comorbidities. Temporal trends in RA-THA utilization were assessed. Outcomes included length of stay (LOS), hospital charges, and in-hospital complications. Matched outcomes were compared with appropriate statistical tests, and relative risks (RR) of specific complications were analyzed. RESULTS: A total 1.9 million THA cases were identified nationwide, of which 2.9% involved robotic assistance. RA-THA utilization increased significantly over the study period (from 1.2% in 2016 to 6.7% in 2022, P 1 favoring RA-THA for most complication endpoints). CONCLUSIONS: In this first nationwide analysis of RA-THA, we found that robotic assistance, while still used in a minority of THA cases, grew steadily in adoption through 2022. RA-THA was associated with shorter hospital stays and a reduced risk of in-hospital complications compared to conventional THA, with higher hospitalization costs. These findings suggest that RA-THA can confer perioperative benefits in routine practice, though its economic impact and long-term clinical advantages remain areas for further investigation. Levels of Evidence: LEVEL III.
Maman et al. (Thu,) studied this question.