The clinical outcomes of robotic-assisted total hip arthroplasty through the direct anterior approach: A meta-analysis and systematic review

摘要

BACKGROUND: Existing evidence on the effectiveness of robotic-assisted total hip arthroplasty (THA) via the direct anterior approach compared to conventional THA is still scarce within evidence-based medicine. This meta-analysis seeks to bridge this gap by consolidating the available data. METHODS: In this meta-analysis, we conducted searches across PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases, covering records from their inception until January 2024. The included studies reported on the differences in clinical outcomes between robotic-assisted THA via the direct anterior approach and conventional THA. We excluded duplicate publications, studies lacking full text, incomplete data, animal experiments, literature reviews, and systematic studies from the analysis. All data were analyzed using STATA 15.1 statistical software. RESULTS: This meta-analysis included 5 cohort studies with a total of 634 patients, with sample sizes ranging from 48 to 208. Of these, 290 patients were in the robotic-assisted group, while 344 were in the conventional group. The combined findings indicated a notable increase in acetabular inclination in robot-assisted THA when compared to that in conventional THA (standardized mean difference [SMD] = 0.75, 95% confidence interval [CI]: 0.02-1.47, P = .043). Moreover, robot-assisted THA demonstrated a significantly lower acetabular anteversion compared to that in the conventional THA (SMD = -0.34, 95% CI: -0.67 to -0.02, P = .039). Robot-assisted THA displayed a significantly diminished limb-length discrepancy in contrast to that in conventional THA (SMD = -0.24, 95% CI: -0.44 to -0.05, P = .015). CONCLUSION: In comparison to conventional THA, robotic-assisted THA through the direct anterior approach results in increased acetabular inclination, reduced acetabular anteversion, and improved limb-length consistency. The Harris Hip Score, however, did not significantly differ between the 2 approaches.