A comparison between robotic-assisted and manual implantation of cementless total hip arthroplasty

Clin Orthop Relat Res. 2010 Apr;468(4):1072-81. doi: 10.1007/s11999-009-1158-2. Epub 2009 Nov 5.


Background: The benefits of robotic techniques for implanting femoral components during THA are still controversial.

Questions/purposes: The purpose of this study was to prospectively compare the results and complications of robotic-assisted and hand-rasping stem implantation techniques.

Method: The minimum followup was 5 years (mean, 67 months; range, 60-85 months). One hundred forty-six primary THAs on 130 patients were included in this study. Robot-assisted primary THA was performed on 75 hips and a hand-rasping technique was used on 71 hips.

Results: At 2 and 3 years postoperatively, the Japanese Orthopaedic Association (JOA) clinical score was slightly better in the robotic-assisted group. At 5 years followup, however, the differences were not significant. Postoperative limb lengths of the robotic-milling group had significantly less variance than the hand-rasping group. At 2 years postoperatively, there was significantly more stress shielding of the proximal femur in the hand-rasping group; this difference was more significant 5 years postoperatively.

Conclusions: Substantially more precise implant positioning seems to have led to less variance in limb-length inequality and less stress shielding of the proximal femur 5 years postoperatively.

Level of evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / instrumentation*
  • Arthroplasty, Replacement, Hip / methods
  • Bone Cements
  • Cementation
  • Female
  • Hip Joint / physiopathology
  • Hip Joint / surgery
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / physiopathology
  • Osteoarthritis, Hip / surgery*
  • Outcome and Process Assessment, Health Care*
  • Pain
  • Postoperative Complications / etiology
  • Prospective Studies
  • Range of Motion, Articular
  • Reproducibility of Results
  • Robotics / instrumentation*
  • Surgery, Computer-Assisted / adverse effects
  • Surgery, Computer-Assisted / instrumentation*


  • Bone Cements