Observational studyJournal of robotic surgery2026
Enhanced and express workflows in robotic total hip arthroplasty: A paired accuracy study using radiographic validation.
Observational study in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Accurate restoration of limb length is an important determinant of functional outcome and patient satisfaction following total hip arthroplasty (THA). Robotic arm-assisted THA enables intraoperative limb-length assessment through different workflows; however, comparative clinical data evaluating their accuracy remain limited. This study aimed to compare the accuracy and agreement of the enhanced and express workflows of a robotic arm-assisted THA system for intraoperative limb-length assessment, using postoperative radiographic measurements as the reference standard. This prospective observational study included 100 consecutive patients undergoing primary robotic arm-assisted THA at a single high-volume centre between January 2024 and January 2025. Each hip underwent paired intraoperative limb-length assessment using both enhanced and express workflows during the same procedure. Postoperative limb-length discrepancy (LLD) was measured on standardized anteroposterior pelvic radiographs at one month. Absolute error between intraoperative and radiographic measurements were compared and analyzed. Eighty-eight hips were available for paired analysis. The enhanced workflow demonstrated lower mean absolute error compared with the express workflow (2.31 mm vs. 3.72 mm). Paired analysis showed a statistically significant reduction in absolute error with the enhanced workflow (median difference − 1.0 mm; p < 0.001). Agreement with postoperative radiographs was higher for the enhanced workflow (CCC = 0.782) than for the express workflow (CCC = 0.620), with narrower limits of agreement. Both workflows provided clinically acceptable intraoperative limb-length estimates during robotic arm-assisted THA. However, the enhanced workflow demonstrated superior accuracy and agreement relative to postoperative radiographic measurements. When operative logistics permit, femoral registration-based workflows may provide greater consistency in limb-length restoration.
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